Wednesday, March 28, 2012

Inside PIH: my Brief Tour of the Global Health Icon*

I remember lazing around my parents' house during Christmas break my senior year of college, contemplating what to do with my life, when my mom called me to see something on PBS. "There's this doctor from Harvard," she said, "doing some work in Haiti that you might be interested in." Sure enough, she was referring to the work of global health guru Paul Farmer, one of the founders of Partners in Health, an international NGO renowned for its community-based, social justice approach to addressing global health.

Now, I'd read one of Farmer's books (and, in fact, used it in my thesis research on structural barriers to accessing HIV medications in the U.S. and Senegal) and I'd been very impressed. How did an NGO started by some medical students years ago become the #2 best NGO, improving health in Haiti, Rwanda, Malawi, and 6 other countries worldwide? The more I learned about the organization and its status, though, the more curious I became about its approach. Its work seemed, in my opinion, to be based in certain communities, providing a wealth of resources to a small group. I understood the rationale behind providing quality services and creating model institutions to areas where access is difficult, working with Ministry of Health officials to create governmental ownership, but what I wondered was about the others who don't yet have access to these types of services. How could we hail an approach that didn't yet reach them?

It was with these thoughts in mind that I embarked on a professional development trip early this year, visiting the countries of Burundi and Rwanda. While the trip provided an excellent opportunity to visit friends and see their amazing work and perseverance during their time abroad, it also provided time to visit these same facilities I'd theoretically questioned.

While in Burundi, I spent four days visiting the PIH-affiliate Village Health Works (VHW). Though I'd never read the famous book, I'd heard founder Deo Niyizonkiza speak about his childhood as a refugee, leaving Burundi and being lucky enough to find opportunity while in the U.S. I had been moved by the story of how the community of Kigutu adopted the facility Deo started upon his return, constructing a  stone road with their bare hands to ensure vehicles could get to and from the clinic.

The famous road.
And when I saw the facility, an absolutely beautiful spread in the mountains of a remote community, I grappled with the issue: how can we justify putting all of this money into one place?
Part of the beautiful facility.
On the way up the mountain.
Our escort (yes, this would be national security)
View from the facility (DRC in the background, I'm told)
Hundreds of patients come daily, seeking services in the facility.
VHW is home to the largest solar panel in Burundi,
and relies on this for everyday operations.
By Day 3, I began to feel slightly different about the place. The doctors and medical technicians were wonderful, trying to provide the best services possible to several patients each day (a reality that unfortunately was missing from so many other international health facilities I'd visited). The numerous volunteers providing considerable support to VHW's operations were so hardworking and asking for so little in return, inspiring me to remember why I often do the things I do. What really touched me as I approached my final day was the sense of community that radiated through the meal times that all staff members ate together each and every day...

to the laboratory technicians who allowed me to practice my French and watch medical tests for hours...

Administering one of dozens of blood tests for the day.
Me acting as though I could actually diagnose malaria
to the children's choir that performed for me over and over when they saw me curiously looking in...

I think this was song number 5. :)
to the women of the cooperatives who tried to teach me to sew (unsuccessfully!)...

The local instructor helps me use the manual
foot peddle sewing machine. 
At least this time I'm peddling with my own feet!
...and basket weave (pseudo-successful), as they were doing to better their own lives.
It's not perfect, but not too shabby (I had a good teacher!)...
Team work creates...
This! (Just kidding, she did this amazing basket on her own,
and they'll soon be for sale through VHW).
The following week, while in Rwanda, I took a day trip to the famous PIH-Butaro Hospital.

On the way...
This is the impressive facility.
Through an informal tour led by an architect from the MassArt group, I learned and was so inspired to see how paying attention to the design of a facility can impact the quality of patient care. Perhaps what struck me more than the mod, simplistic designs and the beautiful scenery was the attention to community:
  • a large tree that would have more easily been removed remained because it was important to the community;
  • a doctor from Brigham and Women's Hospital was warm, friendly, and offered her time to us after just experiencing the death of a patient; 
  • our unofficial "tour guide," who was a friend of a friend, invited us for lunch and spent half his workday hosting us. 
The community tree.
The waiting area, purposefully designed in an open setting
(and a remarkable view!)
One of the wards - simple mod designs with important functions!
There's attention to every piece of detail and
functionality. Here is some retaining wall construction.
Remarkable view from the corridor. 
Views like this can only help you feel better!
The famous PIH fish pond.
The facility was built around these trees as well, as requested
by the community. 

I even had the chance to venture into the rolling hills of the local community, meeting some new "friends" along the way.

My informal PIH tour concluded back here in Malawi, where I had the opportunity to spend a few days visiting friends in the district of Neno. Admittedly, this visit was for pleasure, though I was once again blown away by the hospitality, intelligence, dedication, and integration of American and Malawian staff members with one another and in the community. The "Neno in 15" tour (the number of minutes it took to see the main town) revealed that PIH employs and partners with so many in the community. A trip to the local "bottle shop" (home to 2 varieties of Carlsberg beer, the local fermented maize drink, and a pool table) revealed that almost everyone in the town knew my host by name. Even the fun activities - which involved community-style meals, playing sports with local children, and creating very innovative sources of entertainment with the beautiful mountainous backdrop - all centered around principles of fellowship, community, and cross-cultural exchange.

The view from the guest house
Going up to the hospital.
The hospital.
Neno "Boma" (town)

The market.
Basketball is a serious community affair.
Showing the kids funny pictures on the Ipad. 
My new friends holding their homemade football.
Sunday brunch with the PIH fam.
We "mowed" the grass, Malawi style. 
I even tried...
Fellow-ly love!
Movie night under the stars!!
(Yes, that's a sheet and chairs from the living room).
It's these little acts, and this warmness and commitment from everyone I interacted with in all three countries that have truly challenged my initial perception on approaches like PIH's. I can't say the approach is flawless - and I've yet to find one approach in global health that is - but I was so inspired by many of the strengths I witnessed during my brief visits. I found it incredible to enter into a community that openly pushes for social justice, a term that far too many shy away from because it's too "politically charged." In how many worlds can one sit with a beer and a beautiful mountain backdrop talking about how and why you want to save the world? I was so encouraged to see people of all backgrounds - from Americans and Europeans to people from within local communities - freely interacting with one another, a reality that I've rarely had the opportunity to be a part of outside of my work environment in Lilongwe. I was blown away by how incredible the few people I met were...and that they were altogether in one place! And perhaps most importantly, I'm inspired that criticisms aside, PIH is an organization that truly believes in providing high standards of care to even the poorest and most in-need. I still hope and believe that one day, we will live in a world where social justice is a reality not a pursuit, but along the journey, we can continue to challenge and learn from existing approaches worldwide.

*This blog was independently written without support from PIH for the purpose of sharing my experience while abroad with family and friends.