Partners In Health History

Overview

PIH was founded in 1987, two years after the Clinique Bon Sauveur was set up in Cange, Haiti, to deliver health care to the residents of the mountainous Central Plateau. PIH co-founders had been working in the area for years. The Clinic was just the first of an arc of successful projects designed to address the health care needs of the residents of the poorest area in Haiti. In the 20 years since then, PIH has expanded its operations to eight other sites in Haiti and five additional countries and has launched a number of other initiatives.

Background || 1980's || 1990's || 2000's

1956 – The village of Cange, on Haiti's Central Plateau, is submerged by a dam on the Artibonite River designed and funded by international development agencies to supply electrical power to the capital city of Port-au-Prince, many hours distant. Residents of Cange, all subsistence farmers, receive little compensation for their homes and land, and are forced to move up to the barren hillside as squatters.

1962 – Father Fritz and Yolande Lafontant begin working to provide schooling to the children of the displaced peasants of Cange. They report levels of illness and death that rank among the worst in the world.

1983 – The Lafontants and their colleagues are joined by Paul Farmer, soon to be a first-year Harvard Medical School student, and 18-year-old Ophelia Dahl. Together they establish a community-based health project in Cange, known as Zanmi Lasante ("Partners In Health" in Haitian Kreyol).

1985 – The Clinique Bon Sauveur is established. The two-room clinic will grow over time into a full-fledged hospital with extensive facilities and capabilities.

1986 – The first case of Acquired Immune Deficiency Syndrome (AIDS) on the Central Plateau is identified by health workers based in Cange. The disease becomes prevalent in Haiti's urban slums.

1987 – Partners In Health (PIH) is founded in Boston by Farmer, Thomas J. White, and Todd McCormack to support activities in Cange. They are joined in this effort by Dahl and Jim Yong Kim, also a medical student at Harvard. These activities by now include schools, clinics, a training program for health outreach workers, a mobile unit that screens residents of area villages for preventable diseases, and an ongoing study of sickness and health among the peasants of rural Haiti that will form the basis of Farmer's 1992 book, AIDS and Accusation.

1990 – In Haiti, Zanmi Lasante launches its comprehensive women's health program, Proje Sante Fanm, inaugurating the first women's health clinic in the Central Plateau at our Cange medical center.

1993 – For his work with PIH, Paul Farmer is honored with a MacArthur Award. He uses the prize to establish the Institute for Health and Social Justice (IHSJ), the research and advocacy arm of PIH.

1994 – At the urging of longtime PIH supporter Father Jack Roussin of the Society of St. James in Boston, Partners In Health teams up with poor residents of Carabayllo, a shantytown district on the outskirts of Lima, Peru. Following the community-based model developed in Haiti, they conduct a community survey in Carabayllo, discovering persistent barriers impeding residents' access to health care. Together, they begin working to fill in those gaps, training community residents as health outreach workers and developing health interventions targeted to community members' needs. Workers discover an outbreak of drug-resistant TB, which eventually takes the life of Father Jack.

1996 – PIH and Peruvian partner Socios En Salud begin a joint project to treat drug-resistant TB patients in Carabayllo. Community residents are trained to deliver the complex drug therapies, which include up to seven different antibiotics, in patients' homes. The Institute for Health and Social Justice publishes its first book, Women, Poverty and AIDS: Sex, Drugs and Structural Violence, which wins the Eileen Basker Prize from the American Anthropological Association.

1998 – The first group of drug-resistant TB patients in Carabayllo completes the two-year course of treatment, achieving cure rates of over 80 percent, higher than those reported by many hospitals in the U.S. PIH and the Program in Infectious Disease and Social Change at Harvard Medical School invite international health experts to Boston to discuss clinical findings from the PIH-Socios En Salud project. In light of these results, the World Health Organization begins to rethink its recommendations for treating drug-resistant tuberculosis. In Haiti, Zanmi Lasante and PIH initiate a pilot program to provide antiretroviral "triple therapy" to 50 AIDS patients.

1999 – PIH staff publish an innovative study on the global impact of drug-resistant tuberculosis, in collaboration with Harvard Medical School and the Open Society Institute. The report highlights the importance of community-based care in treating this and other "emerging infectious diseases." Paul Farmer and Jim Yong Kim are appointed by the World Health Organization to help lead the international response by establishing pilot MDR-TB treatment programs and organizing effective delivery systems for antibiotics. In Haiti over 40,000 patients visit the Zanmi Lasante clinical complex, and the Haitian Ministry of Health designates the Thomas J. White tuberculosis treatment facility as the primary MDR-TB referral site for the entire country.

2000 – The Bill & Melinda Gates Foundation announces a $44.7 million dollar grant to PIH and Harvard Medical School to fund MDR-TB research and treatment efforts in Peru, Haiti, and the former Soviet Union. During the next five years, PIH and Socios En Salud will use these funds to expand their community-based treatment program to cover all of Peru, while training health personnel from other countries with high rates of MDR-TB. A foreign aid moratorium on Haiti paralyzes state agencies, and the patient load in Cange climbs dramatically. Encouraged by the remarkable return to health of patients in the pilot AIDS treatment project, ZL launches the HIV Equity Initiative to provide antiretroviral therapy to as many patients as possible, using the existing TB infrastructure to deliver care according to its community-based model.

2001 – Expansion of TB treatment efforts accelerates in Russia and Peru. PIH takes over primary responsibility for clinical care at the project in Tomsk, Siberia. The Brigham and Women's Hospital inaugurates the new Division of Social Medicine and Health Inequalities; PIH co-founders Paul Farmer and Jim Yong Kim are appointed as division chiefs. In Haiti,the pioneering HIV Equity Initiative follows more than 2,000 patients, an increasing fraction of them requiring antiretroviral therapy. Working together with the Haitian government, nonprofit agencies, and local activists, PIH develops an operational plan to apply the lessons of this program to Haiti's entire Central Department.

2002 – The Haiti operational plan is endorsed by the Global Fund to Fight AIDS, Tuberculosis, and Malaria, as methods first developed by PIH in the squatter settlements of central Haiti begin to find expression in poor communities worldwide. Working with the Haitian Ministries of Health, Zanmi Lasante opens a new clinic in the town of Lascahobas, near the border with the Dominican Republic, in an effort to mitigate the effect of the aid moratorium on public services. The number of ambulatory patient visits in Cange alone skyrockets to 200,000. In Peru and Russia, the Bill & Melinda Gates Foundation-supported PIH treatment program for drug-resistant TB is now providing almost 1,000 people with individually tailored drug therapy, integrated in some cases with antiretroviral therapy for HIV. In Boston, the Prevention and Access to Care and Treatment project (PACT) begins offering directly observed antiretroviral therapy to poor residents of the Roxbury and Dorchester districts in Boston.

2003 – In Haiti, ZL expands to four new sites across the Central Plateau; in Cange, it completes construction of an HIV/TB isolation wing, a second surgical wing for emergency surgeries and C-sections, and, in collaboration with the Haitian Red Cross, a modern blood banking facility. Jim Kim transfers to WHO in Geneva, eventually to oversee the worldwide 3x5 AIDS initiative. In Peru, the MDR-TB program expands to five major cities beyond Lima. In Tomsk, 165 new patients are enrolled, and 15 training sessions held for medical staff. PIH collaborates with the RFK Memorial Center for Human Rights on advocacy for Haiti. Paul Farmer testifies before the Senate Foreign Relations Committee, calling for an end to the United States-led de facto sanctions against the Haitian government.

2004 – A coup d’etat in February 2004 deposes Haiti’s democratically elected president, Jean-Bertrand Aristide; unrest and violence ensue in the country; PIH/ZL establishes a National Training Center in Hinche to train health workers from Haiti and other Caribbean nations in all aspects of HIV care and treatment. In Peru, responsibility for MDR-TB patients is officially transferred from SES to the Peruvian Ministry of Health (MINSA); SES steps up its training activities, conducting 58 TB-related courses and training sessions for 1,570 medical personnel. The new Lois and Thomas White Community Center is inaugurated in San Gabriel, Lima. In Boston, PACT launches Youth for Prevention, Action, and Change through Thought (YPACT) to empower at-risk Boston teens. In Russia, PIH enrolls 168 new MDR-TB patients and assists Tomsk partners in securing $10.8 million from the Global Fund to Fight AIDS, Tuberculosis, and Malaria for scale-up of TB treatment efforts in Tomsk Oblast.

2005 – PIH expands operations to sub-Saharan Africa, the epicenter of the global AIDS pandemic, launching an initiative to bring comprehensive, community-based care and treatment to two districts in rural Rwanda. Within eight months, in districts where few people had been tested and virtually none were on treatment, PIH and our Rwandan partner tested more than 30,000 people and enrolled almost 700 on antiretroviral therapy. In Haiti, ZL opens a new hospital in Cerca La Source and expands beyond the Central Plateau to begin treating its first patients in the adjacent Artibonite department. The total number of patient encounters at ZL hospitals and clinics increases to more than 1.1 million for the year. In Peru, SES expands its training and support for the national MDR-TB program and begins providing care to the growing number of HIV-infected people in and around Lima. The new TARGA-Plus program provides both antiretroviral therapy and economic and social support. In Russia, enrollment increases in the MDR-TB treatment program in Tomsk and PIH conducts a workshop for high-ranking officials, laying the groundwork for a series of comprehensive training sessions on management of MDR-TB that will cover the entire country. In Boston, PACT continues to enroll new HIV patients and expands peer prevention training for Latinos in early recovery from substance use.

2006 – PIH launches a new project in Lesotho in southern Africa, bringing testing and treatment for HIV and TB, as well as primary care services, to two remote clinics high in the mountains. In Rwanda, PIH expands it capacity, opening a new pediatric ward and operating room at Rwinkwavu Hospital, and improving staff and facilities at five additional community health centers. In Haiti, PIH/ZL launches a child nutrition program and feeds over 9,000 children nutritious lunches. SES in Peru extends DOTS-Plus treatment for MDR-TB patients and builds two new operating rooms for those patients.

2007 – PIH celebrates 20 years as an organization. PIH begins work in a third country in Africa, Malawi, launching testing and treatment for HIV and TB in Neno District. In Haiti, ZL constructs a new 54-bed hospital in Lacolline and begins manufacturing its own locally-produced peanut-butter medicine to treat severely malnourished children. SES in Peru expands mental health services for MDR-TB and HIV patients and families. In Rwanda, PIH works with the Ministry of Health to launch a national Rural Health Initiative by creating a 55-bed hospital in Burera District in the north of the country, and working with local officials to recruit and train new medical staff and community health workers. In Lesotho, PIHL and partners establish a national treatment program for MDR-TB patients.

2008 – In Haiti, PIH/ZL provides emergency support to thousands harmed and displaced by a devastating series of hurricanes and tropical storms. In Rwanda, PIH works with the MOH to complete a new district hospital in Kirehe and launches a new agricultural program to address hunger and malnutrition. PIH Malawi launches a new electronic medical records system, OpenMRS. The PACT project in Boston builds a replication team to provide support to other community health programs across the U.S. PIH-Russia provides support to locations in Siberia to support MDR-TB patients.

2009 – PIH has 11,000 employees working in 49 health centers and hospitals across 11 countries. In Haiti, PIH launches the first neonatal intensive care unit (NICU) in Central Haiti. In Malawi, PIH doubles the number of clinics where it is providing antiretroviral treatment for HIV from two to four, and constructs a new community hospital in Lisungwi. PIH-Lesotho expands to a seventh remote mountain clinic. In Russia, PIH helps launch MDR-TB programs in two territories bordering on our long-time base of operations in Tomsk, Siberia. In Boston, PACT launches a new diabetes care program.