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Story IIP Digital April 6, 2012

Haiti: Partners In Health

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Last January's earthquake destroyed Haiti's health care system, once at the forefront of the...

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Dr. Louise Ivers is the Haiti Country Director for PIH. Image by Andre Lambertson, Haiti, 2011.

Listening Builds a Community

Within hours after the January 12, 2010, earthquake in Haiti, people of Partners In Health (PIH) started to arrive in Port au Prince to care for injured people caught in the rubble of collapsed buildings. First, the organization's Haitian doctors and staff arrived from towns around the country, including Cange, where Zanmi Lasante ("Partners In Health" in Haitian Creole) is headquartered.

In the first six months after the earthquake, 733 PIH volunteers from 26 U.S. states and six countries worked in Haiti. They set limbs, delivered babies, and treated tuberculosis, malaria and other illnesses. In tent city hospitals and makeshift clinics, Haitian and American doctors and nurses worked side by side.

PIH has provided health care in Haiti for more than 20 years, primarily in rural parts of the country. Today, the staff also are working in the camps that house more than 1 million displaced Haitians. Under green tents, in the blazing sun, they inoculate, offer prenatal checkups and treat basic ailments. "We were at some point seeing 5,000 to 7,000 people a week, and have seen over 100,000 people at the camps," said PIH's Donna Barry.

"Our goal was not to 'Americanize' our surroundings, but to augment the system in place during the emergency response," says Ed Arndt, a nurse practitioner at Brigham and Women's Hospital in Boston, in a PIH blog post he wrote about his volunteer experience. "We were all there to provide direct care and emotional support to our patients."

Solidarity: The Key to Success

The notion of solidarity sets Partners In Health apart from many other charitable organizations. Their efforts have succeeded because they respect and listen to what the people in the impoverished communities want, rather than telling them what they need.

"One thing that was obvious, even in the 1980s, was that Haiti was a veritable graveyard of development projects, with lots of externally imposed programs," said Dr. Paul Farmer, who co-founded Zanmi Lasante with Haitian community leaders and Ophelia Dahl of Britain in 1983. Farmer and Dahl established Partners In Health in 1987.

"So PIH really started as a solidarity organization for Zanmi Lasante, which would be Haitian-run and employ Haitians," Farmer said. In addition to Haiti, PIH works with partner organizations and national health ministries in 11 other countries: Lesotho, the United States, the Dominican Republic, Kazakhstan, Guatemala, Burundi, Russia, Mexico, Rwanda, Peru, and Malawi.

Farmer first went to Haiti's Central Plateau in the spring of 1983 before starting his first year at Harvard Medical School. In the city of Mirebalais, he volunteered in a small clinic run by an Episcopal priest, the Reverend Fritz Lafontant. That's where Farmer and Dahl met.

Ed Arndt, a nurse practitioner, with two of his Haitian patients. The experience in Haiti following the 2010 earthquake was a high point of his career.
Dahl was 18, and hadn't yet decided what she wanted to do with her life, so, at her family's suggestion, she went to Haiti to volunteer.

"I had never been to a developing country," Dahl said. "I grew up just outside London, had been to Europe and the United States, and had lovely, very forward-thinking parents, but had not witnessed real grinding poverty. It was extraordinary, and made an enormous impression. You couldn't turn away from the poverty; it was overwhelming."

Dahl and Farmer traveled to Cange, a small, destitute community of people left landless after construction of a dam flooded their homes and fields. The people were desperately poor, and did not have basic health care. Dahl and Farmer wanted to help. When Dahl returned to England, she began collecting donations. The first was 500 British pounds from a supermarket executive she met at a dinner party. It purchased scales to weigh children.

Meanwhile, Farmer was envisioning a project that would provide health care on a larger scale. "It was a long-term vision. We would start by addressing something small, and partner with Father Lafontant," Dahl said.

Listening Builds a Clinic

Dahl and Farmer trekked the dusty trails at Cange, asking the people what they needed most. "We'd stop at a terrible, dilapidated, cracked hut, and one of the kids would find a parent, who was hacking away at a dusty, postage stamp-sized piece of land, trying to grow maize," Dahl said. The response was almost always the same: They wanted a clinic.

It was the notion of working in partnership with the local community that inspired the organization's name: Zanmi Lasante/Partners In Health. Dahl and Farmer formed a team, which eventually included Farmer's college roommate, Todd McCormack; another Harvard medical student, Jim Yong Kim; and Boston businessman Tom White, who contributed millions of dollars to build PIH's first community-based health project in Cange.

"We started PIH in a squatter settlement," Farmer said. "There I met some of the people I work with to this day. And that's part of what makes PIH special. We are all still working together."

PIH's approach is holistic; the group provides food, schooling and other basic necessities in addition to medical treatment. "We could have given people all the medicine in the world, but if they were going home to a place with no roof or access to water or food, they were going to die," Dahl said. Today, children vaccinated through PIH efforts 20 years ago are healthy adults. Unlike most of their parents, they have had access to education, adequate diets and medical care.

Even after the 2010 earthquake, PIH has worked to provide more than emergency medical care.

"We've increased agricultural outputs," Barry said. "We have a farm near Cange, and they immediately got to work growing corn crops, knowing that food needs would be high, as displaced people had moved out to the Central Plateau." Working with Zanmi Agrikol (Haitian Creole for "Partners in Agriculture"), PIH ramped up production of Nourimanba, a peanut-based food, to fight malnutrition, and provided farming tools to more than 1,000 families.

Today, PIH staff and volunteers view their work in much the same way that Dahl and Farmer did when they were setting up the first clinic in Cange.

"Going to Haiti is extremely daunting, and it was very daunting back then," Dahl said. "But the key is to focus on a small area where you can help, rather than saying 'I am going to combat poverty' or 'reforest the whole of Haiti.' It is about looking at long-term prospects, making partnerships and allegiances, and working together, through thick and thin."

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