Paul Farmer & Partners In Health: One man’s perseverance to help eradicate tuberculosis in Haiti, Peru and Russia leads to collaboration and better healthcare for people.

You would be hard-pressed to find two countries seemingly more dissimilar than Haiti – small, impoverished nation located in the Caribbean Sea – and Russia – former 19^th-century empire and Cold War adversary to the US, and recent heavy-hitter in the energy sector. However, these two countries have at least one characteristic in common: Both have impoverished people who have been woefully under-served when it comes to healthcare.  

Among the people who have answered the call to help those in need in both countries is one man, Dr Paul Farmer, and his organization, Partners In Health (PIH). (Dr Farmer was the subject of Tracy Kidder’s novel: “Mountains Beyond Mountains”.) Together, Dr Farmer and PIH passionately pursue the dual goals of providing healthcare to the poor and teaching communities how to help themselves out of poverty.

Farmer & PIH
It all started with one man’s vision in the 1980s, and his awareness of the extreme poverty and corresponding healthcare needs of the poor in Haiti. In the poorest nation in the Western hemisphere, the humble efforts of a few has grown into one of the best models for delivering healthcare and helping low-income communities develop services to continue that care in the long term.

Dr Farmer’s intense interest and focused commitment to help the poor in Haiti developed while he was a medical student in New England. In fact, during much of his free time as a student at Harvard Medical School, Dr Farmer would pack his books and travel to Haiti’s Central Plateau to work with the poorest of the poor. “I can’t sleep,” Dr Farmer explained, “there’s always somebody not getting treatment.”

His work in the Central Plateau provided the impetus for founding the not-for-profit organization PIH in 1987 with a few other committed partners soon after graduating from medical school with a focus on infectious diseases and medical anthropology. The group defined their mission clearly and succinctly. As the organization’s tagline declares, their efforts would be toward “providing a preferential option for the poor in healthcare”.

Farmer with an elderly Hatian patient (image courtesy of Partners in Health)

In addition to Haiti – and at the urging of longtime supporter Father Jack Roussin – PIH expanded its efforts to tend to the long-ignored needs of the poor residents in Carabayllo, a shantytown district near Lima, Peru. It was here that PIH first encountered tuberculosis (TB) and drug-resistant tuberculosis (MDR-TB).   

Into Siberia they go

It would be this specific work with TB and MDR-TB that would lead to PIH extending its reach far beyond the Western hemisphere to Russian Siberia a few years later. PIH entered Russia in 1998 when they identified the opportunity for research and treatment of MDR-TB in that country. As Dr Farmer explained, “We went back to [the Gates Foundation who had provided grant funding for other projects] and said, ‘Look, you know, there’s a very big problem [with MDR-TB] in Russia as well’,” asking for their support. As result, the grant that provided funds for efforts in Peru was reworked to provide services in Russia.

PIH initially had a narrow medical focus – but vastly wider geographic focus – in Russia than any of its other projects. From a base in the region of Tomsk Oblast, Siberia, PIH began collaborating with the Russian Ministry of Health to combat one of the world’s worst epidemics of MDR-TB.

In partnership with the Division of Social Medicine and Health Inequalities (DSMHI) at the Brigham and Women’s Hospital in the US, PIH focused on improving clinical services for MDR-TB patients in Tomsk while undertaking training and research to catalyze change in the treatment of MDR-TB across the entire Russian Federation. No small endeavor!

These joint efforts got a major boost in 2004, when PIH and DSMHI helped their partners in Tomsk secure a five-year US$10.8-million grant from the Global Fund to Fight AIDS, Tuberculosis and Malaria for efforts to improve prevention, diagnosis, as well as treatment of TB and MDR-TB.

Doctor with TB patient (image courtesy of Partners In Health)

Key components of PIH’s clinical efforts include improving diagnostics in order to detect cases earlier, developing a comprehensive strategy to promote adherence among patients, improving infection control in hospitals and clinics, and decreasing transmission of TB to HIV-positive patients. PIH’s work in Tomsk also encompasses health education for the public, as well as clinical and program management training for medical personnel.

In 2006, PIH launched Project Sputnik, an outreach program to improve the reach and consistency of care needed with MDR-TB patients who were either not receiving care or, more likely, had refused treatment in the past.

Dmitriy Taran, Sputnik’s project director, confirms the meaningful results they’ve realized, explaining, “The application of effective patient management is at the core of our success.” PIH has seen far fewer patients slip through the cracks as a result. As one patient said emphatically upon being asked about the project’s efforts, “We need this program, we need Sputnik.”  

PIH Russia also supervises a treatment program that targets prison colonies in the region specifically intended for inmates with TB.  Such population-specific focus and response with needed resources are making a difference to reduce the spread of the disease as well.

Patients receive TB medication in clinic (image courtesy of PIH)

PIH’s positive effect has indeed spread beyond the Tomsk Oblast. As reported recently by Natasha Arlyapova, PIH-Russia’s summer program for young scientists (a program that is now in its fourth year) is helping set a new standard in public healthcare throughout Russia. What started as a fight against a deadly epidemic has grown into helping one of the world’s largest countries improve the quality of life via better care for its people.

Dr Farmer’s good work certainly has grown considerably these past 30-plus years, from Haiti to Peru to Russia, and other places where the poor remain the most marginalized and vulnerable to killer infectious diseases.

SIDEBOX:
Quick facts about tuberculosis (from the World Health Organization):
• Overall, one-third of the world’s population is currently infected with the TB bacillus.

• Five to 10 percent of people who are infected with TB bacilli (but who are not infected with HIV) become sick or infectious at some time during their life. People with HIV and TB infection are much more likely to develop TB.

• WHO estimates that the largest number of new TB cases in 2008 occurred in the Southeast Asia region, which accounted for 35 percent of incident cases globally. However, the estimated incidence rate in sub-Saharan Africa is nearly twice that of the Southeast Asia region with over 350 cases per 100,000 population.

• An estimated 1.7 million people died from TB in 2009. The highest number of deaths was in the Africa region.

• In 2008, the estimated per capita TB incidence was stable or falling in all six WHO regions (Africa, the Americas, Eastern Mediterranean, Europe, Southeast Asia and Western Pacific). However, the slow decline in incidence rates per capita is offset by population growth. Consequently, the number of new cases arising each year is still increasing globally in the WHO regions of Africa, the Eastern Mediterranean and Southeast Asia.

MORE INFORMATION:
Partners In Health – wwww.pih.org/