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Paul Farmer’s Haiti: Providing Healthcare to the World’s Poorest

It’s now been two weeks since disaster struck Haiti’s capital city of Port-au-Prince, and yet I continue to find myself glued to the media coverage of the earthquake.  I simply cannot believe that something so devastating could happen there.

Admittedly, I don’t know all that much about the small nation that neighbors the Dominican Republic and has a population of just under 10 million.  The little knowledge I do possess is mostly from reading Tracy Kidder’s Mountains Beyond Mountains, which found its way into my hands last summer.

The book chronicles the life of medical doctor and anthropologist Paul Farmer.  Dr. Farmer is the co-founder of an organization called Partners in Health (PIH), which is headquartered in Boston.

PIH is dedicated to providing medical services of the highest-quality to the world’s poorest individuals.

Farmer and his colleagues also aim to challenge the conventional notion, held by many government and public health officials, that treating patients who are living in destitute poverty is somehow wasteful, impossible or simply foolhardy.

Farmer got his start as an international health guru in Haiti.  While still a medical student, Farmer traveled to Cange in the 1980’s where he witnessed a dire need for medical care.

Cange is a small Haitian village that was historically composed of subsistence farmers living in the Central Plateau region of the country.  In the 1950’s, the village was submerged when international development agencies built a dam on the Artibonite River to supply electricity to Port-au-Prince.  The residents were forced to relocate to the nearby hills, which lack the rich soil necessary to grow crops and sustain livestock.  Many of the remaining villagers now live as squatters, without a source of income or food.

It was in this environment that Farmer founded “Zanmi Lasante” (which means Partners in Health in Creole).  Through this organization, Farmer developed a community health model for reaching and treating the very poor.  At the center of this model is the belief that health providers must address the challenging living conditions facing their patients in order to successfully care for them.

For example, Farmer realized that treating small children for diarrheal diseases does not solve the problem if the children continue to drink contaminated water.  Similarly, distributing drugs for malaria, TB and even HIV/AIDS is not enough; it is also necessary for someone to check on the patients and make sure that they are following through with their medicines.

In response to these observations, Farmer started what he called “first line of defense” initiatives, including vaccination programs, clean water and sanitation projects, and, most importantly, a team of local health workers to regularly visit patients, administer medications, and conduct classes on treating minor ailments.

The “second line of defense” was the project that Farmer now refers to as his “oeuvre” (pronounced “oo-vr” and meaning “life’s work”).

In 1985, Farmer and his local partners established a two-room clinic in Cange that has become a full-fledged hospital with state-of-the-art operating equipment and other emergency capabilities.  Farmer hoped that many of his outreach projects would reduce the need for hospital care.  But he also strongly believed that such care should be made available for everyone, regardless of where they live and whether or not they can pay.

Zanmi Lasante’s hospital is unique amongst rural providers in that it waives fees for those who cannot otherwise afford care.

PIH pays for this care by relying on a dedicated corps of donors in the developed world, in addition to government and non-profit grants.

When I first heard about the earthquake, I felt relieved to know that PIH is on the ground in Haiti.  As of late last week, they had sent 22 planes loaded with 144 medical volunteers (including surgeons, nurses, and anesthesiologists) and several thousand pounds of medical supplies.  They have set up 20 operating rooms across the country, and they are also currently responsible for operating the public hospital in Port-au-Prince.

But I also know that in a place where the average life expectancy was 44 years before this disaster, the PIH team and other aid workers have a huge job ahead of them.  One health worker predicts that a substantial number of additional patients will develop life-threatening infections due to a lack of necessary medications.  PIH’s hospitals in Cange and the Artibonite Valley are overflowing with patients who have fled the city.  And surgeons on-site predict that full medical teams will be needed for the next 6-8 weeks to monitor skin grafts and other post-operative care.

PIH needs financial assistance now, more than ever before.  I hope that everyone will give as generously as Mr. Farmer has given of his time, money and talents to the people of Haiti over these past 20 years.  Visit the Partners in Health site to learn more and to make a donation.

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