Wednesday, May 7, 2008

Partners in Health

The Approach, the Vision, and the Results

It is difficult to explain everything that Partners in Health (PIH) does in Rwanda. The simple reason is their programs are too vast and comprehensive to fit in one, two, or ten blog entries. I think the better way to explain what is being done here – in the rural countryside of Eastern Rwanda – is through the philosophy and the approach that has made this non-governmental organization world renowned. PIH is an organization that functions under a human right based, development driven, and comprehensive approach. Now let me clarify that statement through tangible examples.

To call PIH a healthcare or HIV/AIDS non-governmental organization would be limiting. It is very true that they provide unparalleled healthcare, especially with treatment of HIV/AIDS, in research poor settings, such as Haiti, Rwanda, and Lesotho, but their real gains are in addressing the root of many of the problems they encounter – poverty. How do they tackle such a large yet critical component of the human condition? Of course the answer is through healthcare, but that is only the beginning. Healthcare is not only a basic human right in this organization because they don’t stop at the “standard” or the international expectation. Whether it is the successful chemotherapy treatment for pediatric Hodgkins Lymphoma (perhaps a first in the rural districts) or the mixed cocktail antiretroviral therapy that is criticized as not being cost effective, the standard here is that patients deserve everything possible just as if a member of the doctor’s staff where in the same predicament.

Of course there are other human rights that are vital in establishing a just life; education, a livable wage, housing, food are but a few. Many of these key rights are included in the practices and programs on the ground. It fits accordingly to the vision of development. If we talk about education, PIH pays for over a 1000 primary school fees for area children. If we talk about a just wage, the absolute majority of the paid staff (ranging from doctors to cooks) are Rwandan and paid above what the established wage would “normally” be (such as the same position with the Ministry of Health). The concept here is human capacity building. Above all, the over arching goal is to create a model and system that can be run completely by Rwandans in the future, much like PIH’s renowned Haiti program. To attain such a goal, training of local personnel becomes a high priority. It does not stop with medical training. They also run several income generation programs, such as teaching and providing tools for carpentry and sewing. When it comes to a dignified living space, PIH utilizes it many social workers to identify the most vulnerable or needy cases and then works to fill the need, such as a coagulated tin roof or an entire home from scratch. One doctor put it so bluntly that I had to write it down. To paraphrase - if some one has TB and they have a roof that is leaking then the TB is never going to go away. We go in, patch the roof or cover it with a plastic tarp, and now the patient gets better. So simple, yet unfortunately deemed “radical”.

The last example I will provide is perhaps one of the most essential of basic human rights – access to food. It is a topic of international importance and tragedy as the global food crisis continues to plague the world’s poorest. An extra 50 cents for a bagel gets a full page in a Connecticut newspaper, but the impact of the raising of prices effect in the developing world is the difference between eating twice a day to once or worse. In a country that is ravaged by malnourishment, PIH runs several food programs that are aimed at providing the life saving nutrients needed for survival. For instance, the pediatrics ward estimates half its patients are a result of malnourishment. The visible symptoms are so common they have a local name – “Kwashiorkor”. The eyes get puffy, the cheeks get overly chubby, and belly swells. The treatment – food of course – is two months supply and then revaluation after that period expires.

The comprehensive aspect is illustrated through the “accompagnateur” system that first made PIH “famous” in the public health world. It is best explained as a person who the organization pays to daily visit a set group of people in their community to directly assist and make sure the patient is taking their HIV or TB medications. This direct approach has many benefits. First, it accounts for an amazingly high adherence and successful continual treatment rate. Secondly, it creates a leader and a network within the community. Thirdly, it provides as a mechanism for referring someone to the clinic or hospital if they are having complications or other illness. This same practice, which started on the central plateau of Haiti, is now being used thousands of miles away in the rural countryside of Eastern Rwanda.

The Health Ministry has realized that the philosophy and approach of PIH is not only addressing healthcare needs, but in the process it is conducting development initiatives through empowering the locals. The two have partnered to scale up the rural health care sector of the country. It is a new endeavor and challenge for PIH, but not many organizations have the vision or approach to accomplish such a task.


Graham said...

From what you have shared about your passions and ideals I was wondering if you had ever thought of getting to this rural backwater of a backwater country as a pilgrimage of sorts? Journying around the world to arrive at what could be considered the forefront of biomedical care for the poor would be my pilgrimage for sure. Do you mind sharing some personal emotions with your blog readers?

Also, how is the book coming along?


WorldTeach Programs3 said...


So I just finished Mountains Beyond Mountains today, and it's more than fantastic to read the pages to life through your blog. Way to speak to the "O for the P!"

Peace ~Katie S.

Marco Ambrosio said...

Hey Graham,

Sorry it took so long to respond. The last ten days have been full of flights, speeches, and writing. It was certainly something to see Partners in Health in action. They are renowned for their work and it really is the comprehensive approach. It is much more than healthcare being a basic human right. Healthcare becomes the medium for creating a more empowering life. For instance, the amount of skills training, farming techniques, and building up of human capacity is remarkable.

In regards to emotions, my time at PIH was a unique feeling of things coming full circle. I had spent a year in college dedicated to raising funds for this exact hospital/clinic. I had heard field doctors give talks at FACEAIDS conferences and read blogs from FACEAIDS website. Seeing and more importantly documenting the work gave me a sense that progress can be achieved. It is very tangible while on site and that is one of the goals of my work and this book.


Natasha said...

Keep up the good work.