Social Enterprise Institute Social Enterprise Case Series Northeastern University
Partners In Health
Founded: 1987 by Dr. Paul Farmer Current Leader: Ophelia Dahl Location: HQ—Boston, MA Sector: Healthcare Services Website: www.PIH.org
“Look how much they care about us” pect to be flown to Boston if they come to Zanmi Lasante when they‟re sick. In 2000, a young boy named John was brought to Dr. Paul Farmer at Zanmi Lasante (the Partners in The decision was made that as long as there was Health clinic in Cange, Haiti). John‟s age was un- a chance of survival, they had to do everything certain as his birth was undocumented, though he they could to save John‟s life. They finally got John was roughly 11 or 12 years to Boston and his care be- old. He had symptoms which gan immediately. As soon as indicated that he had tuber- he arrived, a team of radiol- culosis (TB) in the lymph ogists, pediatricians, and on- nodes of his neck; however, cologists examined John‟s x- there were a few anomalies rays, bone scans, and CT which made Farmer suspect scans for an hour. They that it might be cancer. found that the cancer had spread everywhere and that The news from tests sent to John was going to die. There Boston was bad: John had was no way of knowing nasopharyngeal carcinoma, an when they decided to try to save him. The ques- extremely rare cancer. However, when caught tion on everyone‟s mind was, “Why did we bring early, 60 to 70 percent of patients could be him here?” cured. John needed to be brought to Boston for care. This would typically cost close to $100,00, PIH‟s mission is to use all of their available re- however, Dr. Serena Koenig was able to persuade sources to make their patients well because they Mass General Hospital to treat him for free. believe that health care is a basic human right. After this case, there was no rush of people hop- A decision needed to be made. A medevac flight ing to be flown to Boston for care and PIH con- for John from Cange to Boston would cost tinued to expand its work in Cange. There was a $18,540. There was a reasonable chance of sur- great buzz about the event among the people in vival if the cancer had not metastasized into his Cange, and they said, “Look how much they care bones, but there was no way of determining that. about us.” The dilemma also had consequences beyond the 1 financial burden of the individual procedure. A Dokte Paul Haitian Zanmi Lasante worker best described the In 1983, before Farmer began med school, he issue: “What are we going to do if another kid traveled to Haiti and worked at Eye Care Haiti, a like this comes to us? It‟s not a one time thing. health care organization that provided mobile eye We‟re not going to close the hospital after this.” clinics. His transformation began as he learned There was growing concern that this was too about the real inequalities in a place such as Haiti. much money to spend on one patient and that a During his stay he traveled with a man named precedent might be set that patients will all ex- Father Fritz Lafontant, who was working to pro-
© 2010. Social Enterprise Institute, Northeastern University. Boston, MA Social Enterprise Institute Social Enterprise Case Series Northeastern University vide schooling to children in the village of Cange, and Todd McCormack to provide a backbone of in the Central Plateau area of Haiti. It was during support for the activities in Cange. PIH was a his travel with Father Fritz that Farmer had what nonprofit organization registered in the US to he called his “slow awakening.” He began to ex- help direct resources from the states to Haiti. Jim perience the extreme levels of illness among the Yong Kim (another Harvard medical student) was poverty-stricken people in the central plateau. another medical director heavily involved in the What frustrated him more than creation of PIH. the inequalities in healthcare Tom White was the ineffectiveness of clin- ics attempting to provide care Tom White was the primary for those same people. Farmer funder of PIH from the begin- decided that Cange, the village ning. White had originally in which Father Fritz worked, been an anonymous donor needed a health clinic. who (through a request to Project Bread from Farmer) That next fall, as Farmer began donated money to ZL for a his schooling at Harvard Medi- bakery. After reading about cal School, he started traveling Farmer in an article, he decid- down to Cange every opportunity he had to try ed that he wanted to meet the man he had sup- and establish a health clinic there. Along with ported. Farmer, when presented with this oppor- Ophelia Dahl (a woman Farmer had met at Eye tunity, responded, “If he wants to meet me, tell Care Haiti), Father Fritz and his wife Yolande, him to come to Haiti.” White obliged and after Farmer helped establish a community-based experiencing life in Haiti, soon became the main health project called Zanmi Lasante (ZL) (Haitian source of funding for almost all PIH operations Kreyol for „Partners in Health‟). Farmer‟s connec- for many years to come. tions in Boston became a huge asset to support- ing the operations of ZL, from monetary dona- Providing a Preferential Option for The tions and free medicines, to doctors that would Poor in Health Care travel to Haiti to support the clinics. What began Lack of access to health care is an issue in all de- as a small clinic soon blossomed to include: veloping nations. The socioeconomic determi- schools, a training program for outreach workers, nants of health in Haiti are similar to those in Pe- mobile screening units, and an ongoing study of ru, Rwanda, and elsewhere. A lack of economic sickness within the region. Farmer soon became opportunity within a certain area can lead to such very well-known among the locals of Cange as issues as poor hygiene and malnutrition, which “Dokte Paul” and was constantly being praised are direct causes of sickness, but can also lead to and sought out for his extraordinary skill, not on- circumstances such as lack of education that can ly with medicine, but with people. decrease knowledge of, and familiarity with, Later, in 1987, Partners in Health (PIH) was es- health services. The poverty which was the root tablished in Boston by Farmer, Dahl, Tom White, cause of these factors also leaves the affected in-
© 2010. Social Enterprise Institute, Northeastern University. Boston, MA 2 Social Enterprise Institute Social Enterprise Case Series Northeastern University dividual unable to pay for healthcare even if they existing public health infrastructure. were aware of the services available to them. These principles lead to three overarching goals Farmer observed this and noticed that there were of PIH : to care for their patients, to alleviate the limitations of health care provided only in clinics. root causes of diseases in their communities, and Farmer‟s solution was that the clinics need to be to share lessons learned around the world. more proactive in working for their patients. The developed world thought their models couldn‟t Since it‟s inception, PIH has now grown to be a work in developing nations, Farmer saw that a multinational organization serving underserved new model needed to be catered to their needs. patients in: Peru, Russia, Rwanda, Lesotho, USA, Malawi, Mexico, and Kazakhstan. Their models of Model of Care care for treating diseases such as HIV and Tuber- The PIH Model of Care was built out of this dedi- culosis have revolutionized the way that the cation to making healthcare work for its patients. world deals with their treatment. It has been a PIH believes that health is a fundamental human steady balance of medical acumen, unrelenting right, not a privilege, and all operations were built dedication to their mission and constant improve- to serve this value The Model of Care is made up ments to their model in order to better serve of five principles: their patients that have made PIH so successful. 1. Providing universal access to PIH runs many complimentary primary health care. The belief socio-economic development was that communities need to programs alongside health care have a foundation of general in conjunction with other non- health services that they can profit organizations and local rely on and trust. governments. They have also developed open-source train- 2. Making health care and educa- ing materials to share best tion free to the poor. Farmer practices with any organization says, “It is counterproductive that wishes to implement a (not to mention immoral) to similar health care program. charge user fees for health care and education to those Future of PIH who need these services most and can afford From the opening story we can see the dilemma them least.” of an NPO providing free health care. PIH has 3. Hiring and training community health workers. PIH expanded its reach rapidly but has also never involves community members in assessment, been starved of resources. It will undoubtedly design, implementation, and evaluation of all continue to be an impactful organization, but how health programs. Specifically, community health far can it go? We have seen how important Tom workers are a vital interface that they utilize White was in funding PIH‟s initial growth, howev- between the clinic and the community to not er, he sadly passed away in 2011. Paul Farmer has only administer many services but to be the played an enormous role as the face of PIH and voice of the community for the clinic. has drawn needed attention and driven many do- 4. Addressing basic social and economic needs. nations to their work . However, people have Fighting disease also means fighting poverty: wondered if a program like PIH can thrive as it through community partners, PIH works to im- has in the past once it‟s founder and leader has prove access to food, shelter, clean water, sani- moved on. PIH‟s model to train local leaders tation, education and economic opportunities. should ensure long-term programmatic success, but can PIH aim to be truly financially sustainable? 5. Partnering with local and national governments. PIH These concerns, however important, will certainly believes in serving the poor through the public not distract PIH from it‟s mission to treat the sector by strengthening and complementing world. Whatever it takes.
© 2010. Social Enterprise Institute, Northeastern University. Boston, MA 3 Social Enterprise Institute Social Enterprise Case Series Northeastern University
Author: Tim Spittle | Editor: Esther Chou | Executive Editor: Prof. Dennis Shaughnessy
References 1 This story is taken from Chapter 25 of Mountains Beyond Mountains by Tracy Kidder (pgs. 261-279). AidforAfrica.org. Member Charities—Partners in Health. Picture (page 2). English, Bella. "In Rwanda, Visionary Doctor Is Moving Mountains Again - The Boston Globe." Bos- ton.com. 13 Apr. 2008. Web. 09 Feb. 2011.
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