Emergic: Rajesh Jain's Blog

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Haiti’s Partners in Health

November 30th, 2003 · No Comments

I read Tracy Kidder’s “Mountains beyond Mountains” recently (will write more on it sometime later – highly recommended). The book is about Dr Paul Farmer who has been working in Haiti for two decades and his “quest to cure the world”. So, it was a pleasant surprise to see a New York Times article on the work going in in Haiti – helped complete the story the book began.

Partners in Health has become an influential model in the frenetic race to expand drug treatment in dozens of poor countries across Africa, Asia and the Caribbean…No program to treat people in the poorest countries has more intrigued experts than the one started in Haiti by Partners in Health which has succeeded by enlisting help from hundreds among Haiti’s vast pool of unemployed and underemployed workers.

The AIDS treatment program here, one of the first of its kind in the world, was started by Dr. Paul Farmer, an American, and the group he founded, Partners in Health. It began giving antiretroviral drugs to patients here in 1999, when such efforts were virtually unknown.

“We didn’t do it to be a model program,” said Dr. Farmer, 44, a Harvard medical professor and anthropologist. “We did it because people were croaking.”

The Spartan model of care used by Partners in Health was born of necessity, but its very spareness is now seen as a virtue by many experts who want the scarce dollars for treatment to stretch as far as possible. Doctors here grafted AIDS treatment efforts onto the existing program for tuberculosis control.

AIDS patients, who will have to take the drugs daily for the rest of their lives, are visited in their homes every morning and evening by a health worker who hands out pills and watches as they are gulped down. Ensuring that the medicines are taken properly reduces the risk that drug-resistant strains of H.I.V. will emerge.

One of the biggest obstacles to rapid expansion of treatment in poor countries is the extreme scarcity of doctors, nurses and high-tech equipment. And the program here has minimized reliance on them. Generally, there are no lab tests done once treatment begins. The only monitor is a scale to weigh patients monthly.

Peasants have been trained to dispense the medicines, draw blood, take X-rays, clean bedpans, measure vital signs and spread the word about condoms preventing H.I.V. infection. Most of the workers who visit patients’ homes are paid a small stipend of $38 a month.

It is the story of how a few can change the world.

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