The Moral Medical Mission: Partners In Health, 25 Years On

How the global health organization grew from makeshift clinics to a state-of-the-art cancer center in rural Rwanda, and what lies ahead (Hint: Still more mountains) 

Construction on Mirebalais National Teaching Hospital, 30 miles north of Port au Prince, Haiti, will be complete in early 2013.

People as enormously successful as Dr. Paul Farmer and Ophelia Dahl often temper discussions of their accomplishments with lines like, "Who could've imagined we'd make it this far?"

So it could initially feel like a discontinuity of character when the intensely modest founders of Partners In Health -- the international organization that directly serves 2.5 million people in 10 countries -- go a little bit Kanye West, offering no such disclaimer. They realized long ago that their organization would become what it is today, because it needed to.

For Farmer and Dahl, it's not about swagger -- it's about meliorism. A belief that the world can be made better by human effort. Before you begin to confuse their resoluteness for arrogance, Farmer will tell you, "It's not rocket science to think out social justice strategies." 

jimpaulophelia 300x200.jpgCofounders of Partners In Health, Dr. Jim Yong Kim (now President of the World Bank), Ophelia Dahl, and Dr. Paul Farmer. Cofounders Tom White and Todd McCormack are not pictured.

If you could go back to the 1980s and tell the twenty-something versions of Dahl (now President and Executive Director of Partners In Health) and Farmer (now Chief Strategy Officer) -- as students treating patients with malaria and tuberculosis in a provisional "clinic" in rural Haiti -- that by 2012 they'd have a pediatric cancer center in Rwanda and be treating HIV in sub-Saharan Africa with higher medication compliance rates than in parts of the United States, they probably would've given you little more than a straight-faced, "Cool." 

It's been almost ten years since Tracy Kidder's biography Mountains Beyond Mountains told the story of Farmer, "the man who would cure the world," and Dahl as they traveled to and from a rural village in Haiti with a small group of Boston colleagues, providing medical care and, in so doing, established what would become Partners In Health. The impact of the organization is only now being realized in the capacity they saw that it could.

"We never fell for the idea that you can intervene with simple, inexpensive tools alone," Farmer told me.

Cange, Haiti around 1999 615x400BW.jpg

Cange, Haiti 1999 -2 615x450 BW.jpg
Paul Farmer in Cange, Haiti

Dahl added, "You have an entire field of public health where the most compelling and dominating arguments revolve around things like cost-effectiveness rather than effectiveness. It's like those bumper stickers: If you think education is expensive, try ignorance. If you think that it's cost-effective to only give oral rehydration to patients in dire need -- the key is bringing groups of people together to build a good, modern teaching hospital."

"A lot of times," Farmer told me, "our younger colleagues here at Harvard will say, 'You're treating a lot of patients with, say, congestive heart failure;' or 'When did you start treating cancer?' The real answer is as soon as you open your doors to whomever feels sick, you see problems that are way more complex than what our public health colleagues at the time in the 80s were accustomed to treating."

Partners In Health celebrates its 25th Anniversary this week, marking the occasion with a Manhattan gala. Ben Stiller and Arcade Fire will be in attendance, among the celebrities lending their cred to the cause. And they have a lot to celebrate.

The coming Spring will see the opening of the Mirebalais National Teaching Hospital in Haiti, 30 miles north of Port au Prince, just three years after the earthquake that killed over a quarter million people. At 300 beds, it will be the largest public teaching hospital in Haiti and the essence of what PIH believes health care in Haiti is capable of achieving. The hospital will house the only CT scanner in any public facility in Haiti. It will be staffed both by local physicians as well as faculty from Harvard's Massachusetts General Hospital and Brigham and Women's Hospital. The operating rooms will have cameras linked to international expert surgeons who can consult for advice in real time from around the world.

Mirebalais National Teaching Hospital in Mirebalais, 30 miles north of Port au Prince 615x400.jpg
Mirebalais National Teaching Hospital

Perhaps most importantly, the Mirebalais hospital will house a training program for local physicians, aimed largely at compensating for the exodus of doctors out of Haiti. Farmer notes that training local care providers has become the core of the PIH model. Teach a man to perform neonatal cardiac surgery, and he'll save lives for a lifetime.

Kidder's biography of Farmer is also titled after a proverb -- a Haitian one that translates: "Beyond mountains there are mountains." According to Kidder, it's "sometimes used to express the idea that opportunities are inexhaustible, and sometimes as a way of saying that when you surmount one great obstacle you merely gain a clear view of the next one."

Applying that proverb to Farmer's work remains poignant these years later, typified by PIH's work in Rwanda. As Partners In Health made inroads against endemic infectious diseases like malaria and drug-resistant tuberculosis, they saw people living longer, and they were able to turn their attention to the next thing that took over where those diseases left off.

neonatal center in 300x200.jpgNeonatal unit at Butaro Hospital, Rwanda

"Rwanda has plenty of cancer, but didn't have a single oncologist," Farmer recalled. "When we started working in Rwanda in 2005, in a public sector facility, we saw cancer every day. We saw more AIDS, TB, and malaria, but now the mortality from those have dropped substantially and life expectancy has gone up pretty dramatically. As people live longer and do better, you see more cancer. So you have to adjust and stay ahead of the curve."

Presented by

James Hamblin, MD, is a senior editor at The Atlantic. He writes the health column for the monthly magazine and hosts the video series If Our Bodies Could Talk.

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