Late in 2007, Benson Chabwera was hired as a security guard by Partners In Health, not long after PIH had begun its partnership with the Malawi government to strengthen the health system in Chabwera’s home district of Neno. 

Chabwera was in his late 20s at the time. He had been married to Vaida Zilozo for about four years and they had a 3-year-old daughter, with another baby on the way. Chabwera started on the night shift for PIH, known in local Chichewa as Abwenzi Pa Za Umoyo, or APZU.

About five months into the job, Chabwera got an additional opportunity. The National Statistical Office of Malawi wanted him to help with the country’s population and housing census, conducted once a decade. Because that work would be in the daytime, Chabwera reasoned, he could do it while continuing to work his PIH security shifts at night.

Sleep was not a factor in his reasoning.

“I slept on the weekends,” Chabwera recalled.  

The decision to take a grueling second job reflects a work ethic and drive that has propelled Chabwera through a series of achievements with PIH, and life, in the 10 years since. Now 37, Chabwera is one of the most well-known and well-liked faces around Neno District—and has transformed himself from a security guard with a high school education into a manager of more than 600 health workers, a graduate with advanced degrees, a pillar of local access to health care, and a strong advocate for PIH’s patient-first model and community-wide impacts.

Basimenye Nhlema, community health director for PIH in Malawi, described Chabwera as “completely hilarious and friendly,” and a compassionate, respectful supervisor. 

“Benson is a pure joy to be around, a ball of energy, always ready to move and work,” said Nhlema, who joined PIH two years ago. “From the time I have worked with Benson, I have found him to be quite committed, dependable, hands-on and considerate.”

Since 2013, Chabwera has been a community health worker (CHW) program officer, one of two for PIH in Neno District. He oversees nearly 100 senior CHWs and more than 500 CHWs, who go home-to-home in their communities to visit families, provide access to services and serve on the frontlines of health care delivery. 

CHWs are the foundation of PIH’s work in Malawi, and in the 10 countries where PIH works. In Malawi’s Neno District—a region so isolated that native Malawians will tell you, “If you’re not from Neno, you don’t know Neno”—PIH supports two hospitals and 12 health centers, working to reduce high rates of maternal deaths, HIV, malaria, malnutrition, and more. 

Henry Makungwa, CHW program manager for PIH in Malawi, said CHWs in Neno are selected in their communities, by their communities, to serve among their friends, family members and neighbors. More than 1,200 CHWs in total work across two Neno regions—upper and lower, or the district’s mountains and its flatlands.  

Chabwera’s position in upper Neno regularly takes him across rugged, mountainous terrain, where dirt roads are rock-filled and steep at best, and flooded or downright impassable at worst, depending on the season. 

His position also requires him to navigate complex interpersonal relationships, a challenge familiar to any manager of a large staff, anywhere. 

“We have an army of over 1,200 CHWs, so conflicts, issues and grievances are always on the table,” Nhlema said.

She said a particular situation stuck in her mind.

“I remember when I had just joined and we were deciding what to do with community health workers who did not meet the new selection criteria,” Nhlema said. “It was clear that based on the needs of the program, we had to lay off those CHWs who were unable to read and write, and I remember vividly the pain and emotional struggle that Benson went through to accept that decision. 

“I recall him trying very hard to negotiate other ways out for CHWs,” she continued. “I see this attribute in him a lot, where he shows tremendous concern for the welfare of CHWs. If I had to summarize his role in the organization, I would say he is a defender of CHWs and the work they do—and I find this totally reassuring.”

Limiting people’s employment opportunities because of a lack of education—likely stemming from a lack of access and other ingrained societal factors—struck close to home for Chabwera. 

He said he had only a certificate of education, equivalent to a high school diploma in the U.S., when he first joined PIH in 2007.

“Initially, I did not know really anything about computers, like the difference between a laptop and a desktop,” he said. 

The stability of his job at PIH empowered Chabwera to pursue higher education on weekends. He and Makungwa traveled to the city of Blantyre every Friday for months, taking classes on Saturdays and Sundays before returning to Neno for the work week. 

They initially paid for their own food and transportation, while urging PIH to rent a house in Blantyre for employees attending school. PIH eventually agreed to the arrangement, which is still in place. 

“We were among the pioneers to advocate for support from the organization when we wanted to pursue higher education,” Chabwera said. “If you go to Blantyre, you will see that there still is a guest house. A lot of people have benefited from that house. A lot of people are still going to school.”

PIH’s investment has paid off for numerous staff members, including Chabwera. 

“Right now, as I am speaking, I have a certificate in accounting plus an advanced diploma in rural and community development—I don’t take that for granted,” Chabwera said. “It wouldn’t have been possible without PIH. It took me from point zero to maybe point 100.”

And he's still climbing. Nhlema said Chabwera is one of many PIH staff members, including several supervisors, who have signed up for an online course this spring through the University of Washington, called "Leadership and Management in Health." The 12-week course runs from April through June. 

"I believe this is a huge milestone and will propel him even further," Nhlema said.  

Over the years, Chabwera's responsibilities with PIH have grown with his education. 

Makungwa said when Chabwera joined the community health department in 2009—ending his tenure as a security guard—he was posted at Magaleta Health Center, where he supervised CHWs in that facility’s catchment area.  

“His interaction with the CHWs as well as the facility’s leadership was superb,” Makungwa said. “He cultivated a very good working environment with different stakeholders, including village chiefs, faith-based organizations and village health committees, just to mention a few.”

His strong performance at Magaleta earned Chabwera a transfer to the Neno District Health Office, in the central community known as the “Boma,” with a larger catchment area and greater number of CHWs. His commitment and hard work continued, leading to Chabwera’s promotion in 2013 to his current role of CHW program officer in upper Neno. 

Kelly Lue, who recently worked in mobile health and research for PIH in Malawi, said the depth of Chabwera’s experience was evident, for example, when members of PIH’s CHW team in Liberia visited Neno for a training event in March 2018.  

“Benson's encyclopedic knowledge of our CHW program was evident from the very beginning. Because of that knowledge and his warm, kind, and hilarious personality, he is an invaluable asset to the CHW team and to APZU,” Lue said. “On one outing, we visited a superstar CHW and Benson translated between her and the Liberia team, so they could ask her questions about her daily work. The conversation was filled with laughter and smiles. It was clear that Benson and the CHW had a great rapport.”

Walking around central Neno with Chabwera, it’s easy to see where that rapport comes from. He’s the kind of person who can’t walk very far without greeting friends and neighbors, and sharing a kind word or laughter with all of them. 

“His interactions—especially with community leaders and community members—are always mature and tactful,” Nhlema said. “Since he is originally from Neno, he understands the people and their communities, hence his ability to carefully maneuver through the cultural nuances of our catchment areas.”

Chabwera’s parents moved to Neno from Mulanje District in 1981, the year Chabwera was born, in search of better land for cultivation. Neno has been Chabwera’s home ever since—and he’s continued his parents’ tradition of working the land. Over the years, he’s grown crops including corn; soybeans; Irish potatoes, known as mbatata; onions; tomatoes, and more. 

While Chabwera said he’s reduced his farming lately, because the revenue isn’t always strong, another kind of growth has continued all around him. A school, new homes, health facilities, better roads, and a larger market all have sprung up in Neno’s central Boma in recent years. 

Chabwera said the cause is clear. 

“All these structures you see, it is because of PIH,” he said, citing the local impacts of an influx of PIH staff; expansion of PIH-supported Neno District Hospital; more than 100 homes for impoverished local residents, built by PIH’s program on social and economic rights; and the development of jobs and infrastructure, related to all those factors.  

In addition to his wife and four daughters—of whom Chabwera is unfailingly proud—Neno also is home to Chabwera’s five siblings, and their children. Chabwera originally was the sixth child of eight. Two of his sisters have passed away. He now is doing all he can to support his extended family, along with his extended community. 

And when the once-a-decade census came around again last fall, adorning homes with chalk-written numbers in villages across Neno, Chabwera didn’t have time to participate.

“This is my home district,” Chabwera said. “Working with my fellow community members, providing support to my fellow brothers and sisters, being able to serve and improve people’s lives—that’s what inspires me.”

For Blessings Henry, a typical school day begins at 3 a.m.

The 17-year-old is in her last year of secondary school in Malawi’s Neno District, a rural region of rugged mountains and arid flatlands in the country’s south, near the border with Mozambique. Blessings uses her early mornings, as well as her evenings, to study before and after classes. These long days devoted to education are in pursuit of Blessings’ ultimate goal: going to medical school and returning home to Neno to work as a doctor.

Blessings wants to become a physician not only to care for patients—she also wants to inspire young women in her community.

“Very few people here have reached being a medical doctor,” she says, citing a fact that’s especially true of women. “I would like to work in Neno so that more girls from Neno have a role model to encourage them to go to school.”

Only 8 percent of men in Neno have completed secondary school, and the rate is even lower for women—just under 5 percent. In one of the poorest districts in one of the world’s poorest countries, most families aren’t able to pay the costs of their children’s education, from books and pencils to required school uniforms and examination fees. Most students—especially girls, due to poverty or early marriage—drop out.

Indeed, poverty nearly prevented Blessings from remaining in school. When her father unexpectedly died, Blessings’ mother and grandmother were left to care for her and her four younger siblings without any consistent income for food or other basic necessities, let alone the fees associated with secondary education. Determined to enable Blessings to stay in school, her mother contacted Abwenzi Pa Za Umoyo, as Partners In Health is known locally, for support.

PIH has been subsidizing Blessings’ education ever since, from seventh grade onwards. She’s one of nearly 150 secondary school students in Neno whose educations PIH helped fund in 2018 alone. Without this support, Blessings says, “I would not have been able to continue school. My family is so vulnerable, there is no way they would have been able to pay school fees or get scholastic materials.”

Blessings’ path to medical school is paved not only by her own hard work and PIH’s support, but also by her mother and grandmother’s commitment to her education. Though she is far from her family during school—she is a boarding student, and must walk at least three hours to get home for visits or breaks—she feels their encouragement echoed in a community of female students and teachers who help and inspire each other.

All of these women have shaped Blessings’ future plans, along with her steadfast belief in herself and other girls.

“It’s important that everyone, either male or female, be given an equal opportunity to attain education,” she says. “No matter how poor and vulnerable they are, all young women around the world should set their goals, be focused, and continue working hard.”

Margarita Perez Jimenez and Martha Domínguez López can both say their lives changed at the age of 14. For Jimenez, that was the year she began working as a traditional midwife in Chiapas, Mexico. For López, it was when she became a single mother.

The two women met around May 2017, when Jimenez was 67 years old and had delivered, she says, at least 5,000 babies, most of them within a mud brick, zinc-roofed shack behind her home in the rural town of Francisco Madero. López could have been among the women who delivered in these modest surroundings, not far from roaming chickens and a black-and-white kitten.

Except at 14, López was a particularly young expectant mother and, therefore, more likely to experience complications during delivery. It was with this in mind that Jimenez and López’s family turned to outside help.

After carrying her pregnancy to full term, López gave birth in Casa Materna, a maternal health center supported by Compañeros En Salud, as Partners In Health is known in Mexico. Since the facility opened in May 2017, nearly 150 women have given birth at the hands of doctors and OB/GYN nurses who staff the clinic 12 hours a day, seven days a week. Three times as many women have come for urgent care and exams in the past six months alone, after being referred from the neighboring Jaltenango Hospital.

Since the facility’s early days, PIH staff have seen an increase in the number of women choosing to come to the Casa for prenatal services and, when the time comes, to deliver. The trend is reassuring, especially in Chiapas, a state where the rate of maternal mortality is among the highest in Mexico—58 per 100,000 women.

Historically, expectant mothers living in the coffee-growing regions of the Sierra Madre visit a traditional midwife for their prenatal care and for help with labor and delivery. When pregnancies are normal and labor is uncomplicated, such a choice is low-risk. But it can be hard to predict whether labor will be complicated. When it becomes so unexpectedly, women and their newborns can be in grave danger, especially when the nearest hospital may be a three-hour drive over treacherous, mountainside roads.

PIH leadership in Mexico knew there had to be a better way to ensure expectant mothers had access to quality care. In late 2016, staff began recruiting and training 34 community health workers specialized in maternal care across the 10 communities PIH serves in rural Chiapas. These women each serve a handful of expectant mothers in their neighborhoods by answering their questions, counseling them on breastfeeding and nutrition, and accompanying them on prenatal visits at nearby PIH-supported public clinics.

When due dates approach, they help patients create a birth plan and advise them to travel in advance to Jaltenango, where they stay near the Casa Materna to await labor—receiving vouchers for meals and free lodging throughout their stay.

None of this is meant to undercut the role of traditional midwives. PIH-supported clinicians partner with these well-trusted women as valuable local resources and allies who can bridge the gap between custom and modern medicine. The organization provides them with birth kits—including sterile gloves and umbilical tape, gauze, and alcohol—and training on how to identify at-risk pregnancies. Midwives are encouraged to refer patients to the Casa Materna should complications arise, and to support them throughout labor and delivery at the facility.

This entire system of maternal health care was just getting in place in the spring of 2017, when López arrived at her aunt’s home in Francisco Madero. At 14, she was four months pregnant, abandoned by her partner, and fleeing her abusive father.

Her aunt, Atanacia Argeta Idalgo, lived on a small farm with her husband and four children a 10-minute walk from the center of town. She welcomed López and took her to see Jimenez, whose arthritic hands had delivered all of her children and had even ushered her into the world, 32 years ago.

Jimenez, a grandmotherly woman with silver-streaked hair and a weathered, round face, gently massaged López’s abdomen to feel the baby’s position. A girl, she said. But how could she be sure?

“The girls are soft; and the boys are hard,” Jimenez said matter-of-factly.

She knew what she was talking about. When Idalgo took her niece to Casa Materna for her routine six-month ultrasound to determine the baby’s sex, staff there confirmed the midwife’s assessment: girl.  

Every several weeks, López walked up the hill into town to visit Jimenez. The teenager grew to trust the midwife’s touch and warm presence. Her pregnancy, thankfully, had been easy—no major aches and pains. She’d had low blood pressure, but that seemed to have subsided over the course of the pregnancy.

So when her due date approached and her abdomen clenched at dawn with early contractions, López and her aunt headed first to Jimenez’s house. The midwife examined the young mother and determined that she still had hours to go, guessing the baby would arrive by early afternoon.  

But Idalgo hesitated returning home to wait, seeing her niece racked with pain. Instead, she drove her 15 minutes to the Casa Materna for a check-up. Staff there examined López and repeated the midwife’s prediction; the young mother still had hours to go and could continue laboring at home.

Idalgo knew López only felt comfortable with Jimenez by her side. Yet she worried that, given her niece’s age, serious complications could arise. The midwife had equal concerns.

So Idalgo talked to Casa Materna staff about the teen’s preference for Jimenez. Without flinching, the attending nurse said, “Well, if she has confidence in her, bring her along.”

That’s exactly what they did. Later on the morning of October 24, López’s labor had progressed and Jimenez thought it was time to return to the Casa Materna. The midwife, aunt, and young mother loaded into the car and sped back to Jaltenango. Staff welcomed them, and one of the nurses attended to their every need throughout their stay.

Around 2 p.m., with Casa Materna staff waiting in the wings, Jimenez helped López deliver a healthy, 7 lb. baby girl with a head full of hair.

“Thanks be to God, she didn’t suffer much,” Jimenez said of her patient.

Casa Materna staff congratulated the women, and informed Jimenez that she was the first traditional midwife to deliver her patient there. It was a major win—proving that local expertise can partner with modern medicine to bring quality maternal health care to women living in rural Chiapas.

Two weeks later, Jimenez sat in the shade of Idalgo’s patio, next to López and her yet-to-be-named infant daughter. The young mother, not one for words, glowed with pride.

Jimenez said Casa Materna staff had invited her to return with her patients. When asked if she would recommend the facility’s services to other women, Jimenez’s answer was easy: “Adelante!” And she would be right by their side.

Four days of unseasonably heavy rains have left 487,000 people in southern Malawi without homes and property, according to official reports. As families prepared for the end of the rainy season and the approach of the harvest, floods swept away acres of farmland, killed at least 30 people, and injured hundreds more. The numbers are expected to rise in the days ahead.

Neno District, where Partners In Health serves 165,000 people, was one of the districts affected. Some 3,500 subsistence farmers lost all or part of their homes, saw their food and possessions damaged or swept away, and suffered injuries as a foot of rainfall caused rivers to burst their banks. 

The president of Malawi, Arthur Peter Mutharika, declared a state of disaster on Friday, March 8. 

“It’s devastating,” says Dr. Emilia Connolly, chief medical officer of Abwenzi Pa Za Umoyo, as PIH is known in Malawi.

PIH staff are assessing the damage and pulling together a response. The two hospitals and 12 health centers that PIH supports weathered the storm and are providing care, yet evidence of the heavy rain’s destruction was clear. 

Throughout surrounding villages, entire walls of mud-brick, thatch-roofed houses collapsed in heaps. Families told PIH staff that they’d lost everything—sacks of maize, cooking pots, plates and utensils. Many have taken shelter in extended families’ and friends’ homes, even a nearby school.

“Everyone's moving in together,” says Connolly. “It's a strain on even those who didn't lose a home.”

While the situation is difficult now, families could face challenges for months. Many lost their crops just as they were maturing, too late to replant and recover what was lost. The Malawian government is mobilizing resources to help with emergency response, including sending essentials such as maize, beans, and rice to the flood zone.

But any such response may take days to reach remote, rural areas, such as Neno District. “It's still going to be quite dire for a lot of people,” says Dr. Luckson Dullie, executive director of PIH in Malawi.

Dullie and Connolly expect an increase in illnesses such as malaria and typhoid as families continue to live in crowded spaces over coming weeks and months with a significant amount of standing water from flooding.

As PIH staff scramble to support as many people as possible, they are also keeping their eyes on the horizon. Another storm, currently ranked Category 1, is approaching Madagascar, and expected to make landfall in Malawi on Thursday.

To help PIH provide emergency response to staff and residents in need of food, mosquito nets, and supplies to rebuild homes, please consider donating here.

PIH staff is working tirelessly to rebuild patients' homes, deploy mobile clinics to the worst-affected areas, and ensure families are safe, housed, and fed amid this disaster. Please, support these efforts with an emergency gift now >>

Authors of a groundbreaking piece published Thursday in The Lancet Global Health argue that universal health coverage, or UHC, is achievable when local health officials are given the proper tools to estimate their communities’ burden of disease and then use that information to determine the level of staffing, supplies, and infrastructure needed to provide high-quality care for everyone in need in their community.

The article, titled “A Practical Approach to Universal Health Coverage,” offers an alternative perspective, a complete reversal from what has been common practice in global health circles. Currently, national ministries of health interested in achieving UHC are told by the ministry of finance that they have a certain designated budget for health and are expected to work from that to see what is possible for their populations. The limited funds often only cover basic services such as vaccines and vitamins, but rarely more complex care for patients, say, diagnosed with cancer,  tuberculosis, or even a complicated pregnancy.

But The Lancet Global Health authors, among them Harvard Medical School professors and Partners In Health clinicians, advocates, and data experts, consider this short-sighted, and have developed an open-access tool they’ve used alongside district officials to help advance steadily toward UHC in remote, rural districts in countries such as Lesotho, Haiti, Malawi, and Liberia.

“This tool represents one pragmatic method to advocate for adequate resources to align inputs with the disease burden, rather than starting with the limitations of a truncated budget envelope,” write the authors, among them Dr. Paul Farmer, a PIH co-founder, Dr. Joia Mukherjee, PIH’s chief medical officer, and Robert Yates, project director of the UHC Policy Forum at Chatham House.

For poor countries, UHC has been an elusive goal, first initiated by national representatives and global health leaders in the Alma Ata Declaration of 1978 in Kazakhstan. Now decades later, at least 400 million people still lack access to basic health care. Several efforts have been made to forge a path toward universal coverage. Projection models, such as the World Health Organization’s OneHealth tool, have successfully helped countries plan and budget for care delivery nationally. But little has been developed to help district officials plan, implement, and monitor their path toward providing affordable and easily accessible high-quality care for all—the definition of UHC set forth by the United Nations in its Sustainable Development Goals for 2030.

PIH leaders saw this gap, and organically over the past 12 years gathered key players to the table to discuss this bottom-up approach of planning for care delivery and subsequently developed an open-source tool they could use hand-in-hand with district health managers.

Formally called the Universal Health Coverage Monitoring and Planning Tool, the interactive spreadsheet enables users to forecast how much additional staff, supplies, and infrastructure will be needed at any given health facility to be sure to reach 100 percent of the estimated burden of disease for that targeted community.

Dr. Jean Claude Mugunga, PIH’s associate director of monitoring, evaluation, and quality, and Adarsh Shah, a monitoring and evaluation analyst, led the tool’s development. They settled on Microsoft Excel because it’s cheap and popular, and therefore more likely to be used. With the help of some pro-bono work by a consultant, Nicholas Luzarraga, they had a shareable prototype up and running by the end of October 2018, in time for the Global Conference on Primary Health Care in Astana, Kazakhstan.

But as early as 2008, PIH was using an initial iteration of the tool when invited by the government of Lesotho to help decrease the rate of maternal mortality across seven rural clinics. Based on projections, PIH staff and their district colleagues estimated what they would need to ensure every expectant mother had access to at least four prenatal visits and delivered within clinics at the hands of trained clinicians. The results were impressive; facility-based births jumped from 12 percent to 56 percent from 2008 to 2010.

Based on that early success, the Lesotho government invited PIH to be its primary technical advisor in a sweeping National Health Reform across four districts, home to 70 health centers. Early analyses indicate substantial increases in service delivery from 2014 to 2017, including a 15-times increase in facility-based deliveries at health centers.

Lesotho is not the only country in which PIH has tested its UHC tool. Colleagues in Haiti, Liberia, and Malawi have also used it to help forecast burden of disease and advocate for increased funding and resources.

The Lancet Global Health authors know that a handful of countries using this tool does not equate to worldwide attainment of health for all. “True global success of UHC,” they argue, “can only be achieved if we have a clear and specific plan for implementation.”

This tool takes the world one step closer.

Partners In Health today named Dr. Sheila Davis as its new Chief Executive Officer. Currently the Chief of Clinical Operations and Chief Nursing Officer, Dr. Davis will succeed Dr. Gary Gottlieb, who in the spring of 2018 informed the board of his intention to step down.  

“Thanks to her vast experience, strategic acumen, unwavering solidarity, and passionate commitment to our mission, Sheila is a brilliant choice to help the organization meet more of the needs of those we serve,” Dr. Gottlieb said.

Partners In Health is a non-profit social justice organization that brings the benefits of modern medical science to the poorest and sickest communities around the world, working to ensure that the universal human right to quality health care is realized. Founded in 1987 by Ophelia Dahl, Dr. Paul Farmer, Dr. Jim Kim, Todd McCormack, and Tom White, it has grown from a small organization in Haiti to a global nonprofit with 18,000 mostly local staff in 10 countries. Last year, it provided access to care to 8 million people.

Dr. Davis holds a doctorate in nursing and has a long history of serving the poor and marginalized—working closely with patients suffering from HIV in the 1980s, both in the U.S. and abroad. For the past decade, she has held multiple cross-site roles at Partners In Health.

After joining the organization in 2010, Dr. Davis was instrumental in the planning and opening of Hôpital Universitaire de Mirebalais, a 300-bed teaching hospital in Haiti. When PIH entered West Africa to help address the Ebola epidemic, Dr. Davis, then Chief Nursing Officer and a member of the executive leadership team, led the organization’s Ebola response. Later, she took on the additional role of Chief of Clinical Operations.

Wearing both hats, Dr. Davis has married her activism, pragmatism, and implementation skills to elevate Partners In Health’s nursing programs and all of the clinical operations, firmly establish the organization’s nursing strategy, and heighten the professionalism and inclusiveness of the organization’s thousands of nurses, midwives, and community health workers.

“Partners In Health has never been better positioned to help provide health care that truly prioritizes the needs of the poor, to show the world that high-quality health care can be provided to all,” Dr. Davis said. “I’m honored and ready to work with my colleagues around the world to do the best for our patients and challenge health inequities globally.”

Dr. Davis will build on the legacy of Dr. Gottlieb, a longtime Partners In Health board member who left Partners HealthCare in 2015 to become CEO of Partners In Health a few months after the organization accepted an invitation to respond to the Ebola epidemic. Under Dr. Gottlieb’s leadership for the past four years, PIH has made rapid progress in improving health and health systems, building on its platform of universal health coverage in some of the world’s poorest countries. Also notable during Gary’s tenure, Partners In Health opened the University of Global Health Equity, a health sciences university in rural Rwanda; worked with key global partners to bring the first new drugs in 40 years to treat multidrug-resistant tuberculosis to more than 2,600 people in 19 countries; and expanded innovative cross-site programs delivering mental health care and services for people with non-communicable diseases where none had been available previously. While retiring from his role at Partners In Health, Dr. Gottlieb will continue his academic commitments as professor of psychiatry at Harvard Medical School, serving on the medical staffs of McLean Hospital and Massachusetts General Hospital. He will also continue to serve on the boards of nonprofit and innovative health care companies and in an advisory role as an executive partner at Flare Capital Partners.

“I, along with the Partners In Health Board, could not be more excited to have Sheila at the helm, to lead us through this important next phase and into a promising future,” said Co-Founder and Chair of the Board Ophelia Dahl. “I have full confidence that Sheila will be an inspiring steward of our mission and a fierce advocate for our patients.” 

For more information and media inquiries, contact Eric Hansen at ehansen@pih.org.

For a printable PDF of this release, click here.  

Jonathan Lascher arrived in Sierra Leone in 2014 to help lead Partners In Health’s efforts to respond to Ebola virus disease in West Africa, site of the world’s largest and most deadly such epidemic. Now executive director of PIH in Sierra Leone, he has a unique perspective on the current Ebola outbreak in the Democratic Republic of Congo, where the disease has raged for a year in the midst of a war zone.

There are many reasons why Ebola and other deadly infectious diseases ravage countries like Sierra Leone and Congo. But “a broken health system seems to be the single largest contributor to how susceptible a country might be to an outbreak, and how quickly it can be stamped out,” Lascher writes for WBUR’s Cognoscenti, the opinion page of NPR’s Boston-based affiliate.

Before Ebola arrived in either of these countries, residents knew that the local health system was broken and couldn’t be relied upon for quality, consistent care. This was not for lack of desire, but for lack of the staff, stuff, space, systems, and social support necessary to provide health care for the neediest.

“Total annual spending on health care in the United States was over $9,000 per person in 2016,” Lascher writes. “In Sierra Leone, it was roughly $107 per person. In Congo, it was just $20. Headstone epitaphs in Sierra Leone or Congo should read, ‘No electricity to keep donated blood cold’ or ‘Only one ambulance for 500,000 people.’”

These are not problems that countries can, or should, solve on their own, Lascher argues. He says the U.S. should lead the drive for global funding, as President George W. Bush did with the President’s Emergency Plan for AIDS Relief (PEPFAR), to work together toward building strong health systems, especially in those countries that require the most support.

Read Lascher’s full article here.

As Doctor Kazinga awaited the results of his final exams for the University of Malawi-Polytechnic in December, more than his own graduation was at stake.

Kazinga, 28, was hoping to achieve a new milestone for the people he loves most.

“No one had ever gone to university in my family,” said Kazinga, who grew up in Malawi’s Neno District, a rural, mountainous region where poverty is endemic and educational opportunities are slim. 

Kazinga had no need to worry about his grades. He passed the finals and, in March, graduated from the university with a bachelor’s degree in mathematical sciences, a field he has loved since high school. He focused on statistics, and minored in computer applications and programming. 

The youngest of seven, he is the first in his family to complete university studies. That’s fitting given his first name, Doctor, which is not to be confused with the title of Dr.—at least not yet, anyway.

Kazinga also is the first university graduate in Malawi who benefited from the Partners In Health program known as POSER, or the Program on Social and Economic Rights.   

PIH is known in Malawi as Abwenzi Pa Za Umoyo, and provides POSER support to more than 100 families in Neno District. That support includes food packages, new home construction, emergency home repairs, and funding for education, transportation, and helping people launch small businesses. The goal is to provide long-term investments in community members, giving them support beyond health care, to help them break out of the cycle of poverty and lead more productive, healthy lives.

Kazinga and his family are well-known to the POSER team in Neno. He grew up in Mpakati Village, about an hour and a half by foot from the PIH office in Neno’s central community.

Initially, his studies at Mwanza Secondary School—nearly 40 miles from his family’s home, in a neighboring district—were supported by the government’s local Office of Social Affairs. During his junior year, funding issues caused an abrupt end to that support. Kazinga had no choice but to leave the school, even though he was only one year away from graduation.

He was spending a few weeks back at his family’s home in Neno when a POSER staff member visited, because of his mother’s poor health. During that visit, the staff member identified Kazinga as a highly driven student, and PIH began paying for his school fees, books, and other materials so that he could continue his education. Then, once he’d obtained his high school diploma, Kazinga attended university in Blantyre, Malawi’s capital, through PIH’s support.

“If POSER hadn’t helped, I would have been done with my studies, because there was no money for school fees,” Kazinga said. “Had it been that they didn’t intervene, I cannot imagine what would have happened. It’s too much.”

Victor Kanyema, POSER manager for PIH in Malawi, said Kazinga is an exceptional young man who always has been hardworking and reliable.  

“I am so proud of all that he has achieved,” Kanyema said. “When he was accepted into university, we worked closely with the PIH staff in Boston to figure out how POSER could continue to support him, despite financial restraints, and make sure he could continue to go to school. We did everything we could to mobilize resources and help with fees, transportation, accommodation, and other basic necessities.” 

Kanyema joined Kazinga, and Kazinga’s father, for the university graduation in March.

“He has been so committed, right through the end of his studies. Something we originally thought may not be possible, we made possible. He is a pioneer,” Kanyema said. “Because of him, another POSER recipient is able to pursue her university studies right now, following in his footsteps. He is making all of us at POSER—and APZU —very proud.”

Kazinga was one of 42 students in the university’s mathematical sciences department, but only 18 of them graduated, reflecting the challenges many students and families face when it comes to paying for education.

Down the road, Kazinga dreams of pursuing a master’s degree in statistics and being involved with research.

He already has a head start in that direction. Kazinga is an intern with PIH’s community health department in Neno, supporting all of the department’s programming, including POSER. He’s using many of the skills that he learned throughout his education to support other people and families across Neno, embodying the POSER spirit of investing in people, so that they can invest in their communities.

In Mokenyakenya Matoko’s schedule for moving lab samples from remote health centers in the mountains of Lesotho to testing facilities in the capital, Maseru, there’s a quick sentence that might be easy to gloss over.

“Tuesday morning, car picks up specimens at Lebakeng and Nkau.”

If only it was that simple.

Matoko is laboratory manager for Partners In Health in Lesotho, a small, landlocked nation in southern Africa, where PIH is known locally as Bo-mphato Litšebeletsong Tsa Bophelo. His story about what it takes to move clinical lab samples—including multi-hour drives with lifesaving, time-sensitive blood tests; frozen gel packs; and a canoe—was one of many told by PIH laboratory leaders from nine countries, at the third annual PIH Lab Workshop and Training. The weeklong event was held in Boston in May.

PIH directly supports more than 25 laboratories across 10 countries, and works with a larger network of labs—in areas such as public health, tuberculosis and more—in each of those countries. Some PIH labs are home to broad diagnostic capacity, while others are designed to focus on a single disease, such as TB. While PIH teams in some countries, such as Sierra Leone, have had labs for only a few years, others, like Haiti, have had them for decades. Laboratory expertise and technology also vary across sites, depending on whether staff are catering to a small clinic or a large referral hospital.

But all of them—large or small, new or longstanding—are absolutely vital to PIH’s work supporting  health care and improving patients’ lives around the world. Dr. Joia Mukherjee, PIH’s chief medical officer, recalled times in the early years of PIH when lab materials and testing were extremely limited, if available at all.  

“It is so much more complicated to take care of patients when you have no diagnostic ability. You don’t know what you’re treating; you don’t know how long to treat it,” Mukherjee said to an audience of PIHers who gathered to meet and celebrate the lab group.

There’s a lot to celebrate this year. Daniel Orozco, director of laboratory services for PIH, said the “flagship” Dr. Paul E. Farmer BSL-3 Laboratory soon will be operating at University Hospital in Mirebalais, Haiti, after several years of construction and equipment transfers. The lab’s designation as a Biosafety Level 3 facility, or BSL-3, means it’s a high containment lab where technicians can work with infectious agents, including drug-resistant TB.

“People said to me, ‘Good luck opening a BSL-3 lab in rural Haiti,’“ Orozco said. “And not only have we done it, we also will demonstrate that it’s possible for it to run at a high standard of quality, while working closely with the national TB reference lab at Laboratoire National de Santé Publique (Haiti’s National Public Health Laboratory).”

Microbiology services to test for bacteria and viruses are starting at PIH labs in Haiti and Rwanda, Orozco added, and capacity is expanding in Liberia and Sierra Leone. Participants in this year’s workshop received training on lab procedures and management, supply chain and procurement, and more.

Participants also focused on Strengthening Laboratory Management Toward Accreditation, or SLMTA, in sessions led by Zimbabwean SLMTA master trainer Edwin Shumba and PIH laboratory program officer Nidia Correa. The training covered basics of SLMTA such as lab management, lab process control, quality assessment, and method validation.

Matoko said the SLMTA training was “extensively informative” in several areas, such as methods to verify manufacturers’ claims about equipment and set appropriate quality standards in labs.

“It was beyond my expectations,” Matoko said. “I’m really hoping that this will impact a lot back home, as far as preparation for accreditation.”

The constant, extensive preparations by Matoko’s lab team were featured in the poster presentations, a highlight of the annual lab workshop since it began in 2017. The poster presentations give participants a chance to showcase their work and learn from the experiences, successes, and growth of their PIH lab colleagues around the world.

Matoko used his poster to describe moving clinical lab samples over Lesotho’s rugged roads and mountains.

Two of the most remote health centers PIH supports in Lesotho are at Lebakeng and Nkau, rural communities several hours from Maseru that are so isolated by mountainous terrain that, in both cases, grassy fields often serve as helicopter pads for urgent visits.  

Matoko said his team visits the health centers by truck to pick up lab samples. The overnight trip requires more than 10 hours of driving, in all. At Lebakeng, the driver calls ahead so someone from the health center can take a 45-minute hike down a mountain—samples tucked in a cooler filled with gel ice packs—and then canoe across a river to hand over the samples.

Work is well underway to shorten that “specimen referral,” as getting lab samples to a testing facility is formally known. PIH works closely with Lesotho’s Ministry of Health, which has provided Lebakeng with a GeneXpert machine to enable TB diagnostics in the remote, mountaintop setting. Plans for a modular building at the facility also are in the works, to provide more space for currently cramped lab work.

Orozco said the three themes of this year’s poster presentations—quality improvement, specimen referral, and lab accreditation—“are all parts of a bigger picture in terms of lab strengthening.”

Zhanel Zhantuarova, a lab quality officer for PIH in Kazakhstan, talked about the heavy amount of documentation required for clinical trials of new multidrug-resistant TB treatment in her country. Some of the paperwork is in Russian, and some in English. Unifying the two can be difficult, because minor differences in language can have major impacts in medical interpretation.

Roger Calderon, laboratory director for PIH in Peru, known locally as Socios En Salud, talked about his team’s work to test for first- and second-line TB drug resistance—one of only three labs in Peru to do both—while shortening test turnaround times from six months to one.

Dr. Paul Farmer, the PIH co-founder and chief strategist for whom Haiti’s new BSL-3 lab is named, praised all of the lab leaders at the workshop and said their work reflects PIH’s fundamental ethic of accompaniment, or “sticking with it over the long haul” while sharing the burden of others.

“You’re really the best at what you do—that’s what I think when I look around the room,” Farmer told the group.

Mukherjee said PIH’s lab teams are “indispensable” and urged workshop attendees to continue their groundbreaking work.

“I think this coordination that you’re all doing together is really going to raise the standard of care for the world’s poor,” Mukherjee said. “So, thank you, because care is better when you know where you’re going. No doubt.”

Mondeh Mansaray sketches the form of his favorite football player with swift, diligent movements of his pencil. Nothing can break his focus as he sits curled-up on a wooden stool and pores over the white page in front of him.

For Mondeh, 14, Saturday morning means one thing: no school. He can sketch in his bedroom, play football—soccer, to Americans—outside with his friends, and help his family with household chores. The relaxed day is a welcome respite from the busy school schedule he follows during the week.

Mondeh’s weekend activities are not unlike those of other youth in his village in Kono District, Sierra Leone. But they are very unlike the grueling routines he knew over the past several years, during extended medical treatment. The scar etched into his neck serves as a reminder of the malignant tumor that used to grow there, and that once left him fighting for his life.

“The swelling would feel painful,” Mondeh recalled. “It was very serious. I was thinking I would not survive the sickness.”

In January 2015, Mondeh was diagnosed with Hodgkin lymphoma, a cancer that targets the immune system; can cause swelling in the neck, armpit, or groin; and is a leading cause of cancer diagnoses for teenagers and young adults globally. Roughly 17 million new general cancer cases were reported worldwide in 2018, including more than 1 million in Africa. 

While cancer care is very limited in Sierra Leone, on West Africa’s coast, Partners In Health is working to change that dynamic. The years that Mondeh spent fighting the disease, and the vital treatment and support he received through collaborations between government health officials, PIH teams, and consulting clinicians around the world, became a model for health care in Sierra Leone that has extended far beyond Mondeh’s own case.   

Like so many, his case started with a lump. For Mondeh, it was on the side of his neck, about eight years ago.

Growing up, Mondeh was always one of the liveliest of the family’s six children, so his parents were confused when he started acting withdrawn and lethargic. Their concern grew when the swollen lump appeared, when Mondeh was about 6. Multiple visits to nearby health centers, however—over the next several years—failed to identify the cause of the growth, or reduce it. It was only when a clinician visiting his village noticed Mondeh, and examined him, that he was referred to the PIH-supported Koidu Government Hospital in eastern Sierra Leone. There, Dr. Yusuf Dibba diagnosed him with Hodgkin lymphoma.  

“When I first met Mondeh, he was struggling to swallow and eat (because of the tumor’s size), so he was losing a lot of weight,” Dibba recalled. “The mass had been growing for around six years at that point, and he had previously been diagnosed incorrectly with TB.”

Chemotherapy in Sierra Leone

With cancer care scarce across the country, for even the most common cases, Dibba worked with Jon Lascher, then chief operating officer for PIH Sierra Leone; Dani Kloepper, a nurse working with PIH during the Ebola response, which began in 2014; Dr. Kerry Dierberg, then executive director of PIH Sierra Leone; and Dr. Joia Mukherjee, chief medical officer for all of PIH, to create a treatment plan and connect with colleagues around the world. The plan involved oral and intravenous chemotherapy. The first step was a biopsy of the tumor on Mondeh’s neck, completed at Connaught Hospital in Freetown, Sierra Leone’s capital.

Mondeh said that while he feared for his future, his family did not waver.

“My father was always sure I was going to survive,” Mondeh said. “He would say, ‘Let me believe,’ so I trusted him. When he was around me, he would never be sad or annoyed.”

Mondeh stayed near the hospital for nearly a year, either as an inpatient or at a nearby hotel, with PIH paying for lodging. His father, Abubakar Mansaray, accompanied him everywhere. PIH clinicians in Freetown kept a close eye on Mondeh, working in partnership with Sierra Leone’s Ministry of Health. After just a few months of oral chemotherapy treatment, the growth on Mondeh’s neck started to shrink.

“My body was tired and weak for a few weeks after each time at the hospital, and then I would feel stronger again,” Mondeh said. “I made a friend in the hospital who also had cancer. His bed was near to mine and his stomach was so big. We would walk around the hospital together to stay strong.”

Cancer care in Rwanda

By August 2016, Mondeh had responded so well to oral medicines that he was ready for the next phases of treatment: medicines via IV. Mondeh and his father flew to Rwanda, where they stayed in a PIH guesthouse for six months while Mondeh received treatment at PIH-supported Butaro District Hospital, which has a Cancer Center of Excellence with a pediatric ward.

PIH is known in Rwanda as Inshuti Mu Buzima. Clinicians at Butaro’s Cancer Center provide treatment for more than 3,100 patients, of all ages, from across Rwanda and from nearby countries such as Burundi and the Democratic Republic of Congo—and, further away, Sierra Leone—where quality cancer care is scarce or nonexistent. The distance means that in addition to facing cancer and enduring treatment, patients also are far from home, families, and school or jobs.  

The clinical team at Butaro noted that despite the challenges, Mondeh and his father were adjusting well to life there soon after their arrival in August 2016.

“Mondeh enjoys having his father here to support him. They have a very close relationship, and they call home frequently during the week,” states a clinician’s report from that time. “Mondeh enjoys talking to his mother, as he misses her, and his father uses these phone calls to check in on the family.”

Butaro clinicians gave Dibba and the Sierra Leonean clinical team regular updates about Mondeh.

“I was happy in Rwanda, but I was also scared because it was my first time going to another land,” Mondeh said. “The swell had gone down but they said the disease was inside my body, so I had to go there to continue my treatment.

“I made friends while I was there,” he continued. “We would play football in the field and go to my house and sit and talk.”

Mondeh’s health rapidly improved. He and his father were able to return to Sierra Leone, where Dibba said family members and clinicians welcomed Mondeh “almost like a king.”

Full recovery  

Dibba saw Mondeh for regular check-ups in the months following his return.

“He pulled through,” Dibba said. “Every day, Mondeh’s father would call me to say, ’Thank you,’ but I would tell him I was just doing my job.”

Dibba added that Mondeh’s father still wouldn’t leave his son’s side.

“Mondeh’s father was imam (spiritual leader) of their village, and he had a farming business, but he stuck by Mondeh over the whole recovery,” Dibba recalled.

As his recovery progressed, Mondeh finally was able to resume his childhood and adolescence. While his case might be among the first cured in Sierra Leone, it won’t be the last.

The World Health Organization projects that the number of new cancer cases in Africa per year—just over 1 million in 2018—will rise to about 2.1 million by 2040. The WHO also expects the continent’s cancer-related deaths per year to skyrocket, from about 693,000 last year to more than 1.4 million by 2040.

That means there has never been a more pressing need for established cancer care in Sierra Leone, to ensure successful outcomes like Mondeh’s are the norm, rather than a rarity.

Mondeh’s recovery was made possible by PIH and Ministry of Health colleagues in two countries working together closely. But Dibba stressed that Mondeh’s recovery does not just represent one life saved—it represents the possibility for cancer care that could save many more patients, who would be cured through access to the right treatment.

“If you don’t do anything, help will not come,” Dibba said. “Mondeh’s treatment was a big lesson for health care providers: You shouldn’t give up because of the limitations. We can’t condemn patients to die because we’ve never done it before. In PIH, we can reach out to people. We find a way.”

Mondeh now is enrolled at a new school, and regularly earns the top spot for performance in his class. Through hard work and support from a personal tutor, provided by PIH to aid Mondeh as he catches up on the school years he missed during his illness, he is well on the way to achieving a newfound dream.

“I plan to be a doctor one day,” Mondeh shared. “When I had that cancer illness, I promised myself I wanted to be a doctor so that I could help other people like me in the future.”

For now, though, Mondeh takes pleasure in quiet Saturday mornings spent sketching in his bedroom, where his most pressing concern is the best colored pencil to use.

Well before his second birthday, Ernesto Roblero’s parents began seeing signs that their infant son was struggling with significant difficulties. But they didn’t know the cause.

Some people in their rural community of Toquiancito, in the southern Mexico state of Chiapas, may have thought it was simply shyness, seeing that Ernesto was reluctant to venture far from his mother, Florinda Roblero. But when he did walk on his own, he would often trip or bump into things—more so than usual for a 1-year-old, his parents thought. Other times, he would come to tears if he wanted something, even when the things he needed were already within reach.

“He was crying a lot,” Florinda said. “I was holding him almost all the time, because if I put him down on the floor, he wouldn’t walk; he would just start to cry.”

“Because he was afraid,” Ernesto’s father, Oscar Roblero, added.

“He was afraid,” Florinda agreed.

The family’s closest option for medical care, then and now, is a clinic an hour’s walk from their community, staffed only part-time by a nurse. As is often the case with public clinics in this marginalized region of Chiapas, there is no doctor. Although travel would be difficult and require money that they had little of, the family made arrangements for the trip to Tapachula, a city some four hours from their home.

There, a doctor gave them the news: Their 1-year-old son had cataracts, in both eyes. What’s more, they were told that the surgeries Ernesto needed would cost 70,000 Mexican pesos, or nearly $3,600. 

“They were charging 70,000 pesos, and we have no money,” Florinda said. “My husband plants his corn crop and beans. That’s all that we grow here. There is nothing more.”

Weakened harvests due to climate change, as well as other factors—including the deaths of Oscar’s parents, within six months of each other—together with ingrained, systemic inequity, all meant that affordable and adequate health care simply hadn’t been within the family’s reach, or means. When they were faced with Ernesto’s condition, they knew they needed help.

Situations like theirs are exactly why Partners In Health—known locally as Compañeros En Salud—is collaborating with Mexico’s Ministry of Health on an innovative partnership to ensure access to quality medical care for families in impoverished communities in Chiapas. PIH works with the ministry to support health care at 10 clinics in remote areas, serving more than 140 communities in rural Chiapas. Primary care often is provided by first-year physicians carrying out their social service year, known as pasantes, whom PIH recruits by partnering with medical schools in Mexico.

Dr. Valeria Macías, director of secondary and tertiary care for PIH in Mexico, was among the first to carry out her pasantía with Compañeros En Salud, which began its work by establishing a strong primary care program in these clinics.

“When I was a pasante, we had everything for primary care. Sadly, for some patients, this isn’t enough. Some conditions are complicated, and a rural clinic, however well-equipped, is not enough,” she said. “We started seeing a huge need for surgeries, cancer treatments, and other specialized care that we could not provide. We saw patients with conditions that they had been suffering from for years or decades without any relief, because they couldn’t access care. The burden was overwhelming.”

As a result, PIH in Mexico decided to create a referral program to serve as a link between local health centers and government hospitals. The Right to Health Care program is dedicated to helping patients navigate the health care system and find all available resources, while addressing the barriers—such as arranging and paying for transportation and lodging—that patients face when trying to access care and alleviate their suffering.

“Wouldn’t we want the same for ourselves and our families?” asked Macías, who became the first coordinator of the Right to Health Care program, following her social service year. Since its inception in 2013, the program has accompanied more than 1,000 patients in accessing life-altering specialized care.

Ernesto’s family connected with the program through a fortunate encounter in a neighboring community.

“We went to ask for some help and there was a man working who told us, ‘Why not go over there [to a clinic in La Soledad]?’” Oscar said, referring to one of the PIH-supported clinics in the region.

Oscar said the man described how health care providers at the clinic had successfully cured several people he knew.

“And because of that, we took the boy to La Soledad,” Oscar said.

The family traveled more than an hour and a half to arrive at the community clinic in La Soledad, a small community not so different from their own. The visit opened a new world of possibility to them. There, Ernesto’s family met with Dr. Montserrat Quesada, a PIH pasante. The doctor wasted no time in referring Ernesto to the Right to Health Care program, which would accompany him to the Pediatric Specialty Hospital in Tuxtla Gutiérrez, the state capital of Chiapas.

Ernesto would come to know the hospital well. The family made several trips, for a series of medical tests and consultations to evaluate Ernesto’s condition and plan his treatment. Each consultation required lengthy travel. From their home, the family would take several modes of public transportation, over several hours, to reach Jaltenango, where they would stay overnight at the headquarters for PIH in Mexico. The next day they would make the three-hour trip to the hospital in Tuxtla Gutiérrez, accompanied by members of the Right to Health Care team.

The trips paid off. Doctors, the family, and PIH staff reached a decision: Ernesto would have surgery in both eyes, one at a time.

Carrying out the surgeries proved to be a challenge. Over several months, numerous factors intervened to push his surgery dates back. The first time, Ernesto fell ill. Then his grandmother passed away, and the date needed to be moved again. Then, in August 2017, they made the trip to Tuxtla for the scheduled surgery, only for hospital staff to discover that they lacked a necessary piece of equipment. Ernesto was discharged and the family made the long trip home, his vision still clouded by the cataracts. Hospital staff asked the PIH team to be in touch in three weeks, to reschedule.

Three weeks later, a magnitude-8.1 earthquake struck just off the coast of Chiapas.

Public facilities, such as schools and hospitals, were closed for inspection to assess possible damage. Hospital administrators made a plan to reschedule disrupted appointments and procedures to dates in the following year—at least four months out.

Without an advocate, a patient like Ernesto—living far away in a remote, marginalized area—was at risk of falling through the cracks during an emergency situation that the overburdened public health system was ill-equipped to handle. Thankfully, he had an advocate in PIH.

After the earthquake, Dr. Francisco “Paco” Rodríguez, then coordinator of the Right to Health Care program, and Miriam Morales, a PIH social worker, went to work advocating for Ernesto. Through the team’s efforts, Ernesto’s two surgeries were rescheduled, and then carried out successfully by year’s end.

Morales emphasized that the entire team was involved in Ernesto’s case.

“We always made sure that one of us from the Right to Health Care team was there with Ernesto and his parents,” she said. “This is a team. Not only our medical staff, but also our logistics staff, know how to navigate the health care system really well and are able to resolve any problem that comes up in the moment, whenever the patient needs it. Accompaniment is a priority in our Right to Health Care program. It was essential so that Ernesto’s treatment was carried out.

“Personally, for me, there is no greater satisfaction than seeing all that was accomplished for Ernesto,” Morales added. “I’m really happy for Ernesto and his parents.”

PIH’s advocacy for the family has continued.

Rodríguez has accompanied them to appointments at the pediatric hospital following Ernesto’s surgeries. He has seen patients through a lot, noting the impact of the adversity they must overcome, as well as the impact that the program has in helping them do so. He watched Ernest playing quietly by himself as they waited outside the ophthalmologist’s office for a follow-up appointment.  

“I think that, due to his condition, Ernesto has developed his own vivid inner world,” Rodríguez observed. “As well as a strong sense of resilience.”

When Ernesto’s name was called in the waiting area, Rodríguez accompanied him as he sat to have his eyes examined, facing bright lights in a dark room. The ophthalmologist, Dr. Alma Leticia González Calderón, decided to give laser treatment for the boy’s posterior capsule opacification, a common follow-up for cataract surgeries, and said she was otherwise pleased with his recovery.

Ernesto quietly tolerated drops in his eyes to prepare him for the laser procedure, followed by another period of waiting and kneeling for the device’s chin platform to be adjusted. With the help of his father and Rodríguez, Ernesto stayed very still as González expertly and patiently orchestrated the lasers, directed with precision at certain points in his eyes.

During a recent visit to the family’s home following the laser procedure, Ernesto’s parents offered agua de carambola—a drink made with star fruit—as well as their gratitude.

“Thanks to Dr. Paco and God, because he helped us,” Florinda said. “Miriam really helped us a lot, as well.”

Ernesto and his older brother, Abimael, were nearby, playing outside.

“He goes out all the time, up and down. He’s all the time seeing little things. If he sees a little red bottle cap, he goes and picks it up, running,” she laughs. “Thank God that now he sees.”

Arriving to this point with her son has been a long road for the family, and there is more that lies ahead. Florinda worries about how Ernesto, now 4, will do in school. But she also has the support and encouragement of the team, who she says have told her how important it is that he go to school when the time comes. She appreciates the accompaniment as they continue on this path. 

“We’re really grateful to all of you,” she said. ”Because just one person, alone, isn’t able to do anything.”

This story originally appeared on the Compañeros En Salud blog, here.

When Françoise Umutesi looks at her 1-year-old grandson, Blessing, she has the smile of someone who once thought she’d never have the chance to meet him.

Umutesi, 45, is a breast cancer survivor. She had a mastectomy in 2012, at Butaro District Hospital in northern Rwanda. She was one of the first patients at the hospital’s Cancer Center of Excellence, which opened that year. The cancer center now sees nearly 2,000 patients annually, young and old, from across Rwanda and from nearby countries, such as Burundi and the Democratic Republic of Congo, where affordable, quality cancer care is scarce or nonexistent. 

Umutesi’s home is much closer to Butaro than most of those patients’. She lives less than an hour’s drive from the hospital, a multi-faceted medical campus that serves nearly 400,000 people in Burera District and is supported by Partners In Health, known in Rwanda as Inshuti Mu Buzima. PIH has supported Umutesi and her family for years, in ways that extend far beyond health care and reflect PIH’s treatment philosophy of including social, mental, and emotional support along with physical.  

Albert Ndayisaba, the Burera manager of PIH’s Program on Social and Economic Rights, or POSER, has overseen that support. His team helps about 200 students in Burera District with materials or money for education, and about 800 households with economic development assistance such as small business loans.

Gilbert Rwigema, chief operations officer for PIH in Rwanda, said those numbers apply to each of the three districts, including Burera, where PIH works—meaning PIH helps 600 students with education and 2,400 households with economic development, across the East African country. POSER teams also have provided food packages to several thousand people in Rwanda this year alone, and direct support for health insurance costs to several thousand more.

Umutesi and her daughters are just a few of those recipients. Ndayisaba and his POSER team have helped the family with ongoing money for education, food packages from 2012-16, and transportation costs—because even with their proximity to Butaro District Hospital, travel there is rarely easy.

The dirt roads are steep, winding, and rugged in Butaro, a rural region where the Virunga Mountains and Volcanoes National Park loom large on the horizon. Subsistence farming is a way of life for many residents of Butaro communities. Umutesi is a farmer, as well, with land and a small livestock enclosure across the dirt road from their home.

Umutesi has been a Butaro resident for all her life. She was born in the house where she lives, which is owned by her mother, 73-year-old Pauline Nyirabazungu. Nyirabazungu still lives there, too—meaning the birth of Blessing added a fourth generation under their small, shared roof.

It is a house full of mothers and daughters. Umutesi has three girls, now grown women. Blessing, the little man of the house, is the son of Umutesi’s 19-year-old middle daughter, Charitine Umamwiza.

On a sunny afternoon in mid-March, Umutesi sat with two of her daughters at a table in the front room, a warm red blanket around her shoulders. Her eldest, 23-year-old Pierrine Uzatuza, held Blessing on her lap. Charitine, the middle daughter, wasn’t home that day, but Umutesi’s youngest, 16-year-old Anitha Dukundane, also joined the conversation.

Ndayisaba was visiting the family that afternoon for a routine POSER checkup, along with Dr. Akiiki Florence Bitalabeho, head of medical education and training for PIH in Rwanda. 

The talk was light, but the topic was heavy. The family shared memories of the time, years ago, when Umutesi was not able to be home, her health was in doubt, and Nyirabazungu had to take care of all of them.

“Life in this house was so difficult,” Pierrine said. “Our grandmother supported us with everything she had.”

In the fall of 2011, Umutesi found a lump in her breast. That November, she had an initial consultation at Butaro District Hospital. Two months later, she stayed at the hospital for a week, and two months after that, in March 2012, she had her single mastectomy. That was followed by a year of chemotherapy, with regular trips to the hospital and exhausting recovery periods that effectively left Umutesi’s mother in charge of the family.  

That initial treatment wasn’t fully effective. Francoise needed radiotherapy, which at the time was not available in Rwanda.

Radiotherapy soon will be more widely accessible in the region—work is underway, for example, to provide radiotherapy at Rwanda Military Hospital in the capital, Kigali. But Kigali is a drive of more than two hours from Butaro, on a rough dirt road down out of the mountains, and most patients needing radiotherapy still need to travel outside the country.

In March 2013, Umutesi went to a hospital in Kampala, the capital of neighboring Uganda. The border is not far from the family’s home, but the trip to Kampala is long. Going by bus can take eight hours. Flights are 45 minutes, but are expensive and first require a long, costly ride to the Kigali airport. Additionally, customs and border crossings are not always certain; as recently as this spring, tensions between Rwandan and Ugandan governments were severely affecting border crossings between the two countries.

Umutesi made the trip by bus—and she made it just once, staying in Kampala for two months to receive radiotherapy.

At that time, Pierrine and Charitine were teenagers in school, and Anitha was just 10. Nyirabazungu, their grandmother, took care of them all. (The responsibility was not new to her. Nyirabazungu had two sons and seven daughters, including Umutesi.)

In the end, the sacrifices and hardships were successful. Umutesi beat cancer and, with regular follow-ups and continued support from PIH, has fully recovered.

Now on the other side of their mother’s illness, the girls have grown into strong women themselves. Pierrine has an associate’s degree in tourism and works for the Rwanda Wildlife Conservation Association. She’s married and lives nearby. Charitine and Anitha are in secondary school, a fact that has not gone unnoticed.

During today’s visit, Bitalabeho—the medical education and training leader—pressed Anitha on plans for her future.

Anitha mentioned that she was focusing on science and hoped to be a doctor one day. Bitalabeho leaned forward and spoke to her intently, describing potential scholarship options, explaining steps she would need to take to reach her goals, and asking questions about her future.

Just across a valley from Butaro District Hospital, where Umutesi received cancer care, is the University of Global Health Equity. The university is a PIH initiative that inaugurated its campus in January, hosts students pursuing master’s degrees in global health delivery, and will accept its first medical school students this summer.

That university, the University of Rwanda, or other institutions could be within reach, Bitalabeho said, if Anitha continued to work hard. Their discussion was friendly and open, but the doctor used the stern tone familiar to parents and educators worldwide, making sure Anitha knew that she would be watching, and that the stakes were high. 

“I will be looking for her name at the university level,” Bitalabeho said.

As the visit ended, the family stood in front of their home. Umutesi held Blessing, their newest generation. She reflected on how during her surgery and treatment, there were times when she had no hope. But those times have changed.

“I didn’t know that one day, I would be a grandmother,” she said.

Leaning over the pregnant patient before her, Regina Korgbendeh touched the woman’s looming stomach and spoke softly in Kono, a dialect common in eastern Sierra Leone: “Thank you for this child.” Blessing an unborn baby is a custom strictly followed in communities throughout Kono District. Once the prayer was complete, Korgbendeh, 48, led her patient over to a chair, where a waiting midwife asked about previous pregnancies and the woman’s medical history. It’s Korgbendeh’s job as a traditional birth attendant (TBA) to incorporate local customs, like this one, into the medical care provided by Wellbody Clinic, a Partners In Health-operated facility.

Historically, TBAs have been the go-to women in village communities for anything related to pregnancy and childbirth. Neighbors often refer to them as “auntie” or “mother” – terms of enormous respect. After experiencing a traumatic labor herself, Korgbendeh decided to become a TBA to prevent other women from enduring what she went through. Many countries, however, now discourage expectant mothers from relying on TBAs, due to the dangers that women face during childbirth without supervision from a trained clinician. Sierra Leone’s government enacted a law in 2010 banning TBAs from carrying out deliveries away from a clinical setting. If found disobeying this law, the punishment is severe—not just for a TBA, but for expectant mothers and anyone else involved.    

Although there’s no question that safety during childbirth should be a priority, restriction of TBAs doesn’t necessarily ensure good health outcomes for women. A lot of women in Kono, for example, consider health care facilities to be strange, nerve-wracking places, meaning many choose to avoid health care facilities altogether during pregnancy. And with TBAs no longer able to assist them, they are left to deliver without any experienced supervision. This sentiment arguably contributes to the horrifying reality for women in Sierra Leone: a 1 in 17 lifetime chance of dying during pregnancy, delivery, or its aftermath.

A new model for safe birth

Dr. Bailor Barrie understood this when he founded the maternal health program at Wellbody Clinic in 2010. He knew that it wouldn’t be enough to offer high-quality medical care without also ensuring that women felt comfortable seeking and receiving the care. To bridge the gap between tradition and a formal health care setting, Barrie pioneered the employment of TBAs, like Korgbendeh, at Wellbody Clinic. His decision to do this was in contrast to the opinions of numerous institutions, however. The World Health Organization discounted the role of TBAs in clinical practice, saying they are simply “an interim solution,” and the United Nations has previously defined TBAs dismissively as “independent (of the health system), with no formal training.”

At Wellbody Clinic though, Korgbendeh and her team of seven TBAs are proving the experts wrong.

“TBAs have an incredibly special bond with Sierra Leonean women. They can connect on a level that clinicians aren’t always able to,” Barrie explained. “When TBA-handled deliveries became illegal, a lot of women were left feeling abandoned during their labors. They feared bad treatment and costly charges at the hospital. At Wellbody, we felt strongly that by engaging TBAs we would begin to evolve the mindset of communities and, more importantly, meet the needs of women.” 

Korgbendeh, after years of experience supporting expectant mothers, echoed these thoughts. “Girls used to hear rumors that they would be treated aggressively. They worried about injections that prick the skin,” she said. “Some believed the clinical staff would test drugs on them. Giving birth was always something women did as a tight-knit group in ‘the bush’ – a  highly honored tradition in village communities.”

Being Sierra Leonean himself, Barrie has a firm understanding of local culture. He approached chiefs of the 14 chiefdoms within Kono to gain their support for his plan to employ TBAs. Korgbendeh remembers being invited by her village chief to be trained as an official TBA at Wellbody Clinic. “Dr. Barrie showed us how to talk to patients in the community about the risks and dangers of delivering alone,” she said. “Patients listen to TBAs because we’re like mothers to them.”   

When Barrie invited PIH to take full responsibility of Wellbody Clinic in 2014, TBAs were firmly embedded into clinical practice. Their inclusion is something PIH has strongly advocated for ever since. A team of eight TBAs now work hand-in-hand with midwives to deliver maternal care. Each TBA lives in a different area of Kono, guaranteeing that women throughout the district of 500,000 people have access to high-quality care and safe births.

Korgbendeh cares for all the women in a region of Kono District called Sefadu. “I’m happy not to deliver their babies myself, though" she said. "Now I’ve been properly trained, I realize how many dangers there are.

“Sometimes after I delivered a baby, I would look down and see a lot of blood on my hands and all over my feet,” she remembered. “It was terrifying. At that time, if a baby died, people would say it was the woman’s fault because she hadn’t pushed hard enough or she hadn’t been cooperative. They would say she had bad water (infected blood).

“Lots of things are done differently at Wellbody Clinic though, and babies don’t die anymore,” Korgbendeh said. “Women no longer deliver on a rug on the hard floor; we lift her high onto a bed. And we don’t cut the umbilical cord with a blade or a piece of thread; everything is clean and we wear gloves. A trained midwife catches all of the dangers and I’m there to soothe the woman.”

Partnership throughout pregnancy

TBAs aren’t just responsible for drawing pregnant women to the clinic either. They accompany women throughout their pregnancies - from prenatal classes and appointments, through delivery and postnatal appointments. The roles of midwives and TBAs are clearly defined. Midwives are trained to administer clinical care, and TBAs play an accompanying role, to both midwives and patients. By providing access to regular training and medical equipment, PIH enables midwives and TBAs to deliver the best possible care, at every point along a woman’s pregnancy.

After blessing her patient’s unborn baby, Korgbendeh said: “This woman hadn’t been to a clinic before today, so she was quite nervous to come. At Wellbody we have a saying: ‘If you push women too hard, you will step on your own toes.’ It’s important not to be impatient, or this woman might not come back to us. When she arrived, staff gave her medicines and a mosquito bed net. She couldn’t believe everything was free. It made her so happy.”

A new mother, sitting outside the postnatal ward with her baby on her lap, expressed gratitude for the TBA who supported her during pregnancy. “My TBA was by my side from month one, all the way to the end. She even visited me afterwards, because a woman’s grave is open for 40 days once she’s delivered her child,” she said, referring to the high likelihood of maternal death after birth. “I now tell everyone in my village to go to Wellbody. I say they will be treated well and given real medicine.”

While the role of a TBA might initially sound like a straightforward one, there’s so much more to it than simply blessing a stomach. A TBA’s position in village communities, such as those throughout Kono, allows her to encourage women to pursue a safer, yet still familiar, type of care.

“Women used to stick together in the village and support one another through pregnancy because this made them feel safe,” Korgbendeh shared. “I tell them that we’re living in a computer world now. There are machines at the clinic to make sure everything is ok with a woman. Why wouldn’t you use that?”

Having access to a safe, compassionate environment during pregnancy is something that all women deserve in Kono, Sierra Leone—and worldwide. PIH recognizes that both the medical and emotional needs of women should be met through their maternal health care. By including and empowering TBAs at Wellbody Clinic, PIH also empower patients and their communities.

“I do this job because I want to help women to see that they deserve the best health care,” Korgbendeh said. “I’m honored to play this role for my community.”  

Read the story as first published on Verve Up.

The world’s latest Ebola outbreak now has spread for nearly a year in the Democratic Republic of the Congo, where the virus has infected more than 2,500 people and killed nearly 1,700.  

PIH has sent two of our top Ebola clinicians to work with partners in the conflict-torn region to help care for the sick, support response efforts, and share lessons learned during the 2014 to 2016 outbreak in West Africa, where the virus infected more than 28,000 people and killed more than 11,000.

Our efforts to rebuild the public health care systems continue to this day in Sierra Leone and Liberia, where we work alongside each country’s Ministry of Health to support comprehensive primary care.

Dr. Paul Farmer, PIH co-founder and chief strategist, and Dr. Sheila Davis, PIH CEO, were deeply involved in PIH’s contribution to the Ebola response in West Africa five years ago. Following last week’s WHO declaration of the current outbreak as global emergency, Farmer and Davis share their thoughts on the necessity of ensuring that patients receive quality care, along with containment efforts, as the international response continues to develop.

Joint Ebola statement by Farmer and Davis

Last week, not long after two of our most Ebola-experienced clinicians returned from the Democratic Republic of the Congo, the World Health Organization declared the country’s Ebola outbreak a “public health emergency of international concern,” or PHEIC. 

That brought to mind the last such declaration, made on August 7, 2014. Partners In Health arrived in Sierra Leone and Liberia that fall, to join the global response to what remains the world’s deadliest Ebola outbreak thus far. Over the five years since that time, both of us have played significant roles in PIH’s work in Sierra Leone and Liberia, and learned a great deal from our colleagues in both countries.

We wish to reflect on that ongoing experience, and share some of the lessons we’ve learned, in contemplating the potential significance of this new PHEIC declaration and the dangerous, unstable conditions in the DRC’s North Kivu and Ituri provinces. We seek not only to share lessons, but also to address some of the pressing issues we saw tardily addressed, or not at all, after the last such declaration, in 2014.

In West Africa at that time, the greatest tensions, and much open conflict, stemmed from the unnecessary and wrongheaded elevation of containment over care. Both must be top priorities for responders in DRC, as must the cultivation of trust within communities where there are scant reasons for having much trust beyond the immediate bonds of family and small communities of worship and work.

This opposition of containment and care tracks closely with tensions between public health and clinical duties. In past outbreaks and pandemics, such tension has served us poorly, whether we look at past epidemics of Ebola and Marburg, Zika, or SARS, or reflect on colonial-era epidemics of plague, Spanish flu, or trypanosomiasis. The list goes on. But we both learned this by coming of age as clinicians during the years AIDS came to be the leading infectious cause of death among young Americans. 

Prevention and care are meant to be complementary and, indeed, mutually reinforcing tasks: High-quality and respectful clinical care can help build trust, especially when it is offered for all ranking health problems as opposed to just one. An Ebola response that ignores other causes of premature death, whether in childbirth or from trauma, has usually engendered mistrust and loud complaint, as is now the case in the DRC. 

A control-over-care paradigm is announced whenever case fatality rates (CFR) are high. In the current DRC outbreak, which has gone on for a year, the CFR is well over 50 percent. It can likely be reduced to lower than 10 percent, given the human and material resources of a modern intensive care unit. However, Ebola outcomes in DRC are also shaped by the following:

• Quality of care (which biosecure emergency care units known as ALIMA cubes and new therapeutics are helping to address) and attention to all medical problems, which are neglected side-by-side with these new Ebola interventions and are key to building trust. 

• Widespread resentment, not only to 25 years of armed conflict in the region, but also to more than a century of (neo-) colonial extraction. 

• Blaming the continued spread of Ebola on people’s disbelief in the virus, which posits cognitive deficiencies as the root of problem. Rather, we should view mistrust as an inclination, a cognitive tendency, or a structured disposition towards eluding depredation.

• The employment of Ebola survivors, which fosters community engagement and improves the quality of expert mercy.

• Blaming the WHO for an underpowered response, which is illogical when their—and the current epidemic’s—funding needs have been slow to materialize.

A PHEIC declaration may or may not solve any of these things. Where this one leads will depend on political will, expert mercy and the resources to back it, and a much bigger dose of humility and social justice.

On most days, Dalitso Mkango is busy selling her vegetables in the market in the central village of Neno District, Malawi. And if she’s not selling her produce, then she’s at home working in her gardens. Rumor has it that she has some of the best produce around—likely because of the fertilizer she uses, a homemade mixture of manure from the goats she cares for at her home. 

How Mkango, 45, came to own those goats—and to use them for a sustainable business—is a story that stretches over 12 years, through a longtime connection between her family, her community, and Partners In Health, known in Malawi as Abwenzi Pa Za Umoyo.

Staff with PIH’s Program on Social and Economic Rights, or POSER, first met Mkango on a visit to her home in 2007, the same year PIH began working in rural Neno District. PIH collaborates with Malawi’s Ministry of Health to provide comprehensive care for more than 140,000 people in Neno, including support for 12 health centers, two hospitals, and more than 1,200 community health workers.

POSER staff, like those health workers, visit people and families at their homes and in their communities, to provide resources and access to care. But while health workers focus on screenings for disease or physical ailments, access to medicine, and more, POSER teams visit homes to focus on social determinants of health, such as access to food, transportation, education, and economic support.

It was through those local visits that the POSER team met Mkango. During a home visit to understand her circumstances and see if there were ways PIH could support her, the team learned about the severe challenges she and her family were facing.

Mkango had learned she was HIV positive in 2006, but had been unable to access antiretroviral therapy until PIH arrived in Neno a year later. She was caring for her three children and ailing mother, despite many economic and social challenges within her family and her community.

Mkango had been taking her HIV medication diligently since 2007, but still was getting sick—likely because, at least in part, she wasn’t getting enough to eat. With her small garden, she was only able to harvest 10 bags of maize at a time, which was not enough to sustain her household of five.

Beyond providing immediate financial support to her and her family, POSER also began helping Mkango work toward financial self-sufficiency.

In 2008, the team invited Mkango to join five other women in a knitting collective. The six of them learned to knit and created wool products that were sold in the United States. After two years, when international hurdles slowed that business, the women came together and asked POSER to help them start a restaurant. From 2010-12, Mkango worked as a co-founder of the eatery, while completing formal business training that POSER provided as the women worked. In 2012, she graduated with new knowledge in business management, ready to manage and grow her income.

A year later, the POSER team gave her two goats, as part of a PIH-Malawi initiative called Goats Pass On. She now has 12 goats, significantly expanding her financial options—she recently planned to sell one of them to pay for home improvements, for example. And over the past five years, Mkango has been able to dramatically increase the amount of maize she produces, by using manure to boost her fertilizer. While she previously struggled to harvest 10 bags of maize, she now reaps more than 55 bags in each harvest, and has made more than 120,000 kwacha ($160 US) selling what her family doesn’t need. With her cabbage, she’s made an additional 250,000 kwacha ($333 US).

And most importantly, her body is much more responsive to her HIV medication.

“I’m just slender, no longer so sick,” she said earlier this year. “Before, we struggled, but now I can grow enough maize and vegetables to feed my family and run my own business. My family has no problems with food or money today.”

Mkango’s story embodies POSER’s mission. Since 2007, POSER has worked with vulnerable families across Neno to overcome financial and geographic challenges and help them realize their right to health. POSER work is rooted in PIH’s belief that medical intervention alone is not enough; in the absence of social and economic support, people can still struggle to care for themselves and their families.

In Malawi, the POSER team distributes more than 800,000 kwacha ($1,066 US) per month to support families with food packages, money for transportation to and from health facilities, household items, and more.  The Goats Pass On initiative is one example of the long-term investments POSER makes in individuals so that they, in turn, can invest in their communities. 

Victor Kanyema, POSER program manager for PIH in Malawi, has known Mkango for years and appreciates how hard she has worked to achieve success with her goats and gardens.

“It’s not easy to manage goats, you know how they are,” he said. “It requires a lot of work, which is a unique part of this program and shows you how committed Dalitso has been to raising her many goats.”

When asked about Mkango, POSER officer Edwin Kambanga smiled.

“She’s always been full of so much energy,” he said. “She’s very special to POSER.” 

In part because of Mkango’s success, the POSER team is working to launch a large-scale, multi-year initiative to expand the goats program and related training. Kanyema is optimistic that many more people across Neno could benefit from goats, and their source of fertilizer.  

With her ongoing HIV treatment and growing economic opportunities, Mkango is doing better than ever—an outcome that Kanyema hopes to replicate across the district.

“We are proud of her and appreciate all of the lessons she has provided to our programming, which ultimately can help others in Neno,” he said. 

Dr. Paul Farmer, Partners In Health co-founder and chief strategist, recently sat down with Chelsea Clinton for a full episode of the Clinton Foundation’s new podcast, “Why Am I Telling You This?” Clinton has followed Farmer's work for 20 years, since she was a student at Stanford University, and sits on PIH's Board of Trustees. 

In their wide-ranging and dynamic conversation about global health, Farmer and Clinton discuss his fundamental belief that everyone has an obligation to help narrow, and eventually erase, the health divide between the world’s rich and poor. Topics also include why and how Farmer helped launch PIH, well before the phrase “global health equity” existed; combating HIV/AIDS in Haiti and the 2014 Ebola epidemic in West Africa; and building comprehensive health systems in countries as diverse as Lesotho, Rwanda, and Mexico.

The podcast launched May 1. Farmer and Clinton’s conversation is the fifth episode, titled “Paul Farmer Fights for Global Health Equity.”  

Listen to the full podcast episode, here.

A recently published study showed strong success for treating hepatitis C with new antiviral medicine in Rwanda, potentially creating a model for broader treatment plans across the region.

Several of the study’s co-authors are affiliated with Partners In Health, which is locally known as Inshuti Mu Buzima and has worked in Rwanda since 2005. The 2017, PIH-led study tracked 300 patients who had 12 weeks of treatment at Rwanda Military Hospital in the nation’s capital, Kigali, and resulted in successful treatment for 87 percent of them. Co-authors found no previous large-scale, antiviral hepatitis C treatment studies in sub-Saharan Africa, where limited treatment data is available and where new treatments for the virus only have been introduced in recent years.

“This is the first large-scale prospective study reporting direct-acting antiviral outcomes in sub-Saharan Africa,” the study states. “The high adherence and treatment success without intensive support measures…support the feasibility of (hepatitis C) treatment decentralization and scale-up in sub-Saharan Africa.”

The successful trial and evidence of effective antiviral treatment among Rwandan patients was followed by the Rwandan government's December 2018 launch of its plan to eliminate hepatitis C in the country by 2024—significantly sooner than the World Health Organization’s target of 2030.

“This research allowed us to provide evidence that hepatitis C treatment is effective and safe, and can be used in Rwanda, and hence, in comparable settings in sub-Saharan Africa,” said Fredrick Kateera, chief medical officer for PIH in Rwanda and a co-author of the study.

The government’s roadmap plans to screen more than 4 million Rwandans and treat about 112,000 people living with hepatitis C—an often-overlooked, highly treatable liver disease. With a projected budget of $113 million, officials aim to treat 90 percent of all infections, expand the health workforce, provide medications, develop monitoring tools, and launch vertical micro-elimination along with wider, community-based awareness and treatment campaigns.

Co-authors shared results of the antiviral drug trial in a report titled, “Treatment of Chronic Hepatitis C Virus Infection in Rwanda with Ledipasvir–Sofosbuvir,” which appeared in the December 2018 issue of the Lancet Gastroenterology & Hepatology Journal. Co-authors also presented their findings at the 2018 International Liver Congress in Paris.

PIH’s research helped the Rwandan government successfully negotiate a lower cost for the medication, prompting the progressive elimination plan described in a recent editorial. That editorial, “Rwanda Launches a Five-Year National Hepatitis C Elimination Plan: A Landmark in Sub-Saharan Africa,” appeared in the April 2019 Journal of Hepatology.

“We sought to test the drug in an African population to characterize its impact,” said Kateera, who worked on the trial alongside Dr. Neil Gupta, formerly chief medical officer for PIH in Rwanda. “Through ongoing negotiations, the price of direct-acting antiviral drugs in Rwanda is expected to continue to decrease substantially.”

The work highlights how antiviral medication could effectively cure people with hepatitis C and reduce the number of Rwandans living with the virus, currently estimated at 3 to 4 percent of the adult population. More broadly, the plan contributes to a goal of essentially eradicating the viral liver infection in sub-Saharan Africa. 

Globally, 71 million people live with chronic hepatitis C. The often asymptomatic—and therefore undiagnosed—blood-borne virus commonly is transmitted through contaminated injections or transfusions. The virus currently has no effective vaccine and can cause serious scarring of the liver, known as cirrhosis, or liver cancer.

Personal stories emerged from the study.

A 30-year-old Rwandan man, for example, faced severe virus-related symptoms before joining the PIH-led trial, a year after he was diagnosed with chronic hepatitis C. He couldn’t afford antiviral medication, and had dropped to an unhealthy weight after being put on a strict diet to avoid liver damage. Upon enrollment into the study, he began taking medication. With proper nutritional counseling, he gradually returned to a healthy weight. Three months after completing the treatment, there was no trace of the virus in his system.

A Rwandan woman, meanwhile, was planning her wedding when she found out she had contracted the virus a few weeks earlier, while donating blood. She postponed her wedding to undergo treatment.

“The virus was undetectable after this patient completed the treatment as part of the trial. She was so thankful that she invited the study team to her wedding,” said Dr. Fabienne Shumbusho, a Rwandan clinician who co-authored the study.

Researchers leading the trial conducted assessments and evaluations before, during, and after treatment. They also found that the medication does not require extensive follow-up care, making treatment even more accessible.

Those successfully treated in the trial saw a significant improvement in physical and mental quality of life, including reduced symptoms of depression and higher success rates at work. Patients were excluded from the study if they had other advanced ailments, such as uncontrolled HIV. Globally, 25 percent of hepatitis C patients have HIV, according to the Centers for Disease Control.

Some of the patients in the study were less likely to be cured by the medication tested, because they have a unique genotype for hepatitis C that is more common in Africa than other parts of the world. In August 2019, PIH in Rwanda is launching a new study to explore potential treatment across genotypes.  

Mariama Alieu was heavily pregnant when she was admitted in June to Koidu Government Hospital in eastern Sierra Leone. The 30-year-old mother of four said she’d suffered ill health for more than a year without receiving the correct diagnosis and felt like she would “always have the flu.

“My chest hurt and there was so much pain in my bones,” Alieu remembered feeling. “A bitter fluid would always come up my throat.”

At the hospital, doctors examined her, ordered the proper tests, and received news from the laboratory that Alieu tested positive for hepatitis B—a disease she’d never heard of up until her diagnosis. She was immediately started on antiviral therapy, which she will take for the rest of her life.

A new hepatitis B clinic

Alieu is one of the first patients to be treated at PIH’s newly opened hepatitis B clinic at Koidu Government Hospital in Kono District, in partnership with Sierra Leone’s Ministry of Health and Sanitation. Staff will strive to care for as many people with the condition as possible through screening, monitoring, and treatment, with the goal of enrolling 75 people into care within the first year. All these services are free of charge. 

PIH and government partners hope that what’s accomplished in the new hepatitis B clinic will inform a forthcoming national treatment guideline that will be applied in clinics and hospitals across Sierra Leone. They also will vaccinate 200 medical students in Freetown and vaccinate or treat all clinical and non-clinical staff at Koidu Government Hospital in coming months. The partners’ plans were announced during a joint press conference and seminar hosted in Freetown on Friday, July 26. 

Of the five types of viral hepatitis (A, B, C, D, and E), hepatitis B is one of the most prevalent forms worldwide. It is an infection of the liver that is transmitted through the blood or body fluids of an infected person and, if left untreated, can cause irreparable damage to the liver, altering its function completely. Around 350 million people have the infection, 10 times more than those living with HIV. 

The World Health Organization estimates that nearly 10 percent of the population in Sierra Leone is infected with hepatitis B, a sharp contrast to the less than 1 percent of the population in the Caribbean and North and South America. Yet despite its high prevalence, clinical testing, immunization, and treatment across Sierra Leone is limited. 

Screen, treat, monitor, repeat

That is no longer true at Koidu Government Hospital. Patients admitted with HIV or tuberculosis, as well as maternal health, blood bank patients, and the newborns of mothers with hepatitis B, will now be automatically referred to the hepatitis B clinic for screening via a blood test. 

“By increasing screening, we will catch patients earlier,” said Dr. Marta Patino, an infectious disease specialist working at KGH. “We need to make sure the entire structure is in place—screening capabilities, a database, clinicians ready to treat the patients, everything.”

People who test positive for the virus will be continually monitored through regular appointments at the hepatitis B clinic. And those meeting the criteria for therapy, like Mariama, will be started on antiviral treatment, which is a lifetime daily tablet. 

“It’s crucial to stop growth of the infection and worsening of the disease, both for the individual’s health and to prevent the spread of infection to others,” Patino said. “The liver needs to be preserved to live a long, healthy life. Some of our younger patients have been refused opportunities, like joining the military, because of this illness.” 

Preventing transmission of hepatitis B

Koidu Government Hospital clinical staff face a huge risk when exposed to the blood of hepatitis B patients, which is why PIH will introduce a vaccination and treatment plan for all clinical and non-clinical staff, or around 1,000 people. Those found positive for hepatitis B, who also meet the criteria for treatment, will be provided therapy and monitored regularly through the hepatitis B clinic. Staff who are negative will receive a three-dose hepatitis B vaccine, which is a standard occupational health measure in most health facilities around the world, but not something commonly provided in health facilities across Sierra Leone. 

Children under 6 are one of the most likely groups to develop a chronic form of the infection, and so transmission of hepatitis B from infected mothers to newborns is another focus for the hospital’s clinicians. Looking ahead, they hope to vaccinate newborns of mothers living with hepatitis B within 24 hours of their birth, as this has been shown in many countries to reduce the rate of chronic infection to less than 1 percent among immunized children. 

Back in June, Alieu’s top concern was how her diagnosis would affect her newborn. “I worry about my pikin,” she said, referring to her baby in Krio. “But I believe in God that the doctors will help me.” 

A recent piece in “Goats and Soda,” National Public Radio’s global health and development blog, shows how Partners In Health is leveraging strong collaborations to provide low-cost, lifesaving care for children with cancer in northern Rwanda.

The July 26 piece, “How to Bring Cancer Care to the World’s Poorest Children,” features the Butaro Cancer Center of Excellence. The facility is part of the PIH-supported Butaro District Hospital, operated in close collaboration with Rwanda’s Ministry of Health. PIH has worked in Rwanda since 2005 and is known locally as Inshuti Mu Buzima. The cancer center opened in 2012 and now sees nearly 2,000 patients per year, from across Rwanda and from nearby countries where affordable, quality cancer care is scarce or nonexistent. 

The NPR piece cites a PIH study—published in 2018 in the Journal of Global Oncology—that showed children with cancer could get full treatment, follow-up care, and social support at the Butaro facility for a fraction of the costs found in high-income countries.

"There's this myth that treating cancer is expensive," Dr. Christian Rusangwa, deputy chief medical officer in charge of chronic care for PIH in Rwanda, and a co-author on the study, said in the NPR piece. "And that's because the data is almost all from high-income countries."

Read the full NPR piece here.

Nicole Jabo, 25, assessed the financial burden of type II diabetes on adult patients in her home country of Rwanda.

Her classmate Leila Dusabe, a 27-year-old from Burundi, examined barriers to voluntary male circumcision, hoping to increase rates of a practice that’s widely viewed as a preventative measure against HIV.

They described their capstone projects earlier this year while seated in a well-equipped classroom—flat-screen monitor, Wi-Fi connectivity, whiteboards, movable tables and walls—at the University of Global Health Equity, a Partners In Health initiative in northern Rwanda. Joining them were two of their classmates: 34-year-old John Bosco Kamugisha, from southern Uganda, and 37-year-old Peter Muriuki, from Nairobi, Kenya.

The projects are the culmination of their studies in UGHE’s one-year Master of Science in Global Health Delivery program, which 24 students, including these four, began in September and completed this month. They have been the first class to live and study full-time on UGHE’s new campus, formally inaugurated in January in the rural region of Butaro.

Mountains surround the campus, which is not far from Volcanoes National Park—extinct volcano Mount Muhabura looms on the near horizon, in fact, its peak sometimes shrouded by clouds. The borders of Uganda and Democratic Republic of the Congo also are just miles away, close enough that when referring to those countries, people at UGHE often point over nearby hills as if to say, “just over there.”

But as the four students discussed their experiences and work at UGHE, what it meant to be the first class living on campus, and their interactions with the Butaro community, their heads were far from the clouds. They had immediate concerns, such as studying and projects ahead of graduation in August.  

Kamugisha's capstone tracked hand hygiene among health care workers at PIH-supported Kirehe District Hospital in eastern Rwanda, to reduce transmission of infections between staff and patients.

Muriuki's capstone sought to better integrate agriculture into prenatal care, by recruiting women in early stages of pregnancy for farming programs that could improve not only their own nutrition, but also their babies’.

“When mothers are better nourished, it means the children are better nourished, as well,” he said.

Dr. Rex Wong, director of UGHE’s Bill and Joyce Cummings Institute of Global Health—and academic leader for the master’s program—said in previous years the capstones were individual projects, conducted independently by students taking classes part-time.

With this year’s advent of full-time students, UGHE staff adjusted the format. 

“We wanted to really create a program that’s more applicable to the real world, so we decided to do group projects,” Wong said. “That’s the real world—you have to work with people.”

Students also had to partner with a Rwandan organization for their capstones. Muriuki and his capstone partner, for example, worked with Gardens for Health International to explore prenatal agriculture programs.

“We treat the organization as a client—you see what they need,” Wong said. “That means students are not just creating a project that nobody can use. It’s practical, and mutually beneficial.”

The collaborations also could create networks for students, potentially leading to internships or full-time jobs after they graduate. But UGHE leaders are just beginning to see how that might play out.

“This is our first cohort doing it,” Wong said.

One of many firsts for this year’s class.

UGHE is an initiative of Partners In Health, which strengthens health systems in 10 countries around the world. PIH began working in Rwanda in 2005, and is known locally as Inshuti Mu Buzima. The private, independent university was launched in 2015, with significant investment from the government of Rwanda. Construction of the campus began a year later, with classes and part-time studies temporarily based in Rwanda’s capital, Kigali. Part-time students complete UGHE’s master’s program in two years, rather than the single-year program that the on-campus students have pioneered.

UGHE’s 250-acre (100-hectare) campus is about 80 miles north of Kigali, with distinctive white buildings adorned with traditional, patterned art known as imigongo. The campus has housing for up to 200 students and staff, a dining hall, and six academic buildings. There’s also a recreation center and outdoor basketball court, a dining hall with floor-to-ceiling windows and locally catered meals, and land for expansion in coming years. 

And for several months earlier this year, Jabo and her classmates were the only students living there.

“It feels like you move into this place and you have a house all to yourself,” Jabo said. “It’s been really nice, but we’ve had to be flexible in a way, with all the different changes.”

Those changes have included ongoing construction and touch-ups, and a January inauguration ceremony with guests including Rwanda President Paul Kagame. All of that came along with ongoing preparations for UGHE’s first batch of medical students, who arrived on campus in early July to start a six-year program.

But dealing with a new and changing living situation—while also, of course, completing an intensive, yearlong master’s program—is nothing these students couldn’t handle.

After all, they got to UGHE in the first place. The university received more than 300 applications across 26 countries in 2018, for the 24 spots in this year’s class. The students who made the cut come from 11 countries—there’s representation on campus from Malawi, Tanzania, Kenya, Uganda, Rwanda, Burundi, Nigeria, Sierra Leone, Nepal, Canada, and the U.S.

Bringing all of those backgrounds together and guiding students to success takes an academic leader with a global outlook. Wong certainly fits that bill: he’s lived in 14 countries, is familiar or fluent in seven languages, and previously directed a hospital management program at Yale University. He also is an engaging, kinetic personality with energy to spare.

But he slows down and smiles when talking about how UGHE’s diverse students have learned from each other and grown over the past year. The only language that’s remotely common to the students’ 11 countries is English, which is the language of classes and educational materials on campus.

Interacting with each other in a shared, mostly non-native language has vastly improved the students’ communication skills and global perspectives, Wong said.

“In September, when I first saw them, they couldn’t even stand up and talk to people—I mean, they could—but you see how they stand up and present themselves now,” Wong said. “It changes month to month and week to week.”

Wong said the student body’s multicultural makeup creates constant lessons inside and outside of UGHE classrooms.

“You cannot even stage it; you just have to let it happen organically,” he said. “We are all learning from each other.”

He mentioned a recent class that included a discussion of needle exchange programs. Many of the students had worked with such programs before, and all contributed different experiences—sometimes with conflicting opinions about cultural norms and practices.  

“Just like anywhere else, there are always personality issues and different cultural competencies,” Wong said. “Sometimes you offend people because you didn’t know (their background or perspective). But I think that happens on any campus, anywhere.”

One thing you might not find on just any campus is the high level of poise and personal maturity held by UGHE students. Whether from diverse life experiences or professional expertise, it quickly becomes apparent that these are not the carefree collegians found in many western universities. These are driven, passionate students who are approaching their studies with purpose.   

Kamugisha, for example, came to UGHE from Masaka Regional Referral Hospital in central Uganda, where he works in Global Emergency Care.

“Doing this master’s will help me perfect my leadership, managerial and research skills,” he said of UGHE’s global health delivery degree.

Dusabe is a public health practitioner in Burundi, and said her year of study will provide invaluable professional development.  

“When I heard about UGHE, I thought about the quality of the education, first of all,” she said. “The exposure and quality of experience I will gain from here will be really good for me.”

Muriuki, the oldest of these four students, said he’s worked for more than 10 years on the research side of the health industry, in areas including maternal and neonatal health, child health, and nutrition, often with vulnerable populations such as people living in Nairobi slums. 

“I was ready to upgrade my skills—and that included skills in research, because I saw that UGHE was research-focused,” he said. “Equity in health care is one of the big topics and debates happening around the world, and I wanted to learn what I could do to ensure equity.”

Jabo is the youngest of the four, and the only one who came to UGHE straight from undergraduate education. She graduated last year from the University of Texas at Tyler, about two hours east of Dallas.

She said UGHE felt like an opportunity to immerse herself back into the culture of her home country, and get a close look at Rwanda’s health system.

“One of the things that most drew me here was that I wanted to work and live in Rwanda. It just seemed very timely that this university opened and it aligned with so much of the work I wanted to get involved with,” Jabo said. “It’s like learning about the health system of my country once again, and being an active participant in some of the solutions, now and in the near future.”

Dusabe said the small community on campus this year has enabled a lot of open dialogue with UGHE staff, guest lecturers and professors from institutions around the world, Rwandan health leaders, and others.

“We really hope that continues (in coming years),” she said.

Kamugisha has taken a local focus, doing his best to meet people in the Butaro community surrounding the campus. He attends Mass at a nearby Christian church and takes regular evening walks in the community.

“By now, I know most of the people around Butaro,” he said, adding that residents have been helping him perfect his Kinyarwanda language abilities.

Jabo and her classmates are well aware that being the first students to live and study on UGHE’s still-new campus brings responsibilities, along with the perks.

“I feel like we get to set the tone for even the other students who come after us,” Jabo said. “Whatever traditions and types of things we leave here, will continue for years and years to come.”