Haiti/Zanmi Lasante Project History

The roots of Partners In Health go back to 1983, when we began working with a group of community activists based in the central plateau of Haiti.

Members of the organization that is now called “Zanmi Lasante” (Haitian Creole for “partners in health”) had been working in the region since 1956, when Haiti’s largest river, the Artibonite, was dammed as part of an international development project.

Like many other large and poorly planned foreign aid projects, this one harmed the local communities. One such community, Cange, was flooded entirely, drowning thehomes, fields and hopes of its population of peasant farmers. The families were not reimbursed for their losses, and the electricity generated by the hydroelectric dam was consumed far away in the capital city. For years, Cange consisted of a few shacks and a dispirited core of “water refugees” who had fled to less fertile land on the eroded hillside as the water rose behind the dam. But with the financial and moral support of many Haitians and North Americans, Zanmi Lasante and the people of Cange built a large school and completed a project to bring clean water to the dusty settlement. Thus, Cange began to resemble a real village.

Father Fritz Lafontant and his wife Yolande first started working in the village in 1962 to provide schooling for the children of the displaced peasants of Cange. In 1981, they established a primary grade school, Ecole Bon Sauveur, to educate children in Central Haiti.

From the time of their arrival in Cange, the Lafontants encountered levels of illness and death that rank among the worst in the world. In 1983, they enountered two foreigners who shared their determination to do something about it. That summer as he was getting ready to start medical school back in the United States, Paul Farmer came to Haiti. In short order, he teamed up with the LaFontants and a young British woman, Ophelia Dahl, to establish Zanmi Lasante. Their first initiative was to assess of the needs of the community. Their assessment confirmed that the community members had many needs … and that they put health care—and a hospital—at the top of the list

Two years later, in 1985, PIH founded the Clinique Bon Sauveur, which serves as the departmental hospital for Haiti’s Central Department (population: 500,000). (There are 10 communes or districts in the Central Department, each of which has a government health post.) Few patients use the posts as they are understaffed and have little in the way of tests or medications. Most of the health care in the Department is provided by Clinique Bon Sauveur, which also provides outreach through bimonthly mobile clinics to the 10 communes and a cadre of 200 health care workers that perform health promotion and disease prevention activities.

In 1986, Zanmi Lasante documented the first known case of HIV disease in Haiti’s Central Plateau and began offering voluntary counseling and testing free of charge. ZL’s early efforts to address the epidemic were focused on HIV prevention and education. But other activities flourished as well. With generous and unwavering support from Thomas J. White, the wealthy owner of a Boston construction company, ZL established schools and clinics, developed a training program for community health workers, created a mobile unit to screen residents of villages in the area for preventable diseases, and conducted an ongoing study of sickness and health among the peasants of rural Haiti. In 1989, ZL initiated a community-based TB program, and in the following year, it launched a comprehensive women’s health program, Proje Sante Fanm, to provide family planning, prenatal care, and treatment for sexually transmitted infections.

ZL opened its first inpatient facility in 1993 and found that more than 40 percent of the patients were HIV-positive. A two-year study revealed that more than half of ZL's HIV-positive patients, including pregnant women, also suffered from active tuberculosis. ZL became the first clinic in Haiti to offer zidovudine free of charge to all HIV-positive pregnant women to prevent mother-to-child transmission of the virus. The availability of treatment dramatically increased uptake of voluntary counseling and testing for HIV among pregnant women and lowered the rate of mother-to-child transmission in our catchment area.

In 1998, ZL and PIH managed to acquire small quantities of the combination of antiretroviral drugs known as "triple therapy" and started a pilot treatment program for 50 patients suffering from advanced AIDS. At the time, global health experts maintained that treatment was too expensive and too complicated for poor countries, that scarce resources should be funneled exclusively into prevention programs ... and that the tens of millions of people infected by HIV in developing countries should be written off for dead. ZL's pathbreaking program showed that community-based treatment could literally bring AIDS patients back from the brink of death. It also provided some of the first evidence that the availability of treatment encourages people to undergo testing that is essential for successful prevention. Encouraged by the remarkable return to health of patients in the pilot program, in 2000 ZL and PIH launched the HIV Equity Initiative to expand treatment to as many patients as possible.

While ZL was earning global attention and renown for its work with HIV, it continued to strengthen its work in primary health care and in providing for basic social and economic needs. With the opening of Clinique Bon Sauveur’s operating room, 1996 saw the Central Plateau's first surgeries under general anesthesia, including a woman with a placental abruption. The new operating room was put to the test by a team of visiting surgeons, who joined our own medical staff in order to care for the sick of the Central Plateau.

Responding to the increasingly acute needs of the community, the PIH-ZL team built and inaugurated the Pavillon des Enfants to expand the Clinique Bon Sauveur’s inpatient capacity. This facility introduced high-quality inpatient services to a population with great need but an inability to pay for these services elsewhere.

Over the next few years, ZL constructed another school—Lekòl Popilè Bel Air (People’s School of Bel Air)—and completed water projects in Chapoteau, Bois Joli, and Kay Epin . In 1999, the Thomas J. White Center, a 30-bed infectious disease treatment center, was built and designated by the Ministry of Health in Haiti as the primary MDR TB referral site for the country. The following year, an ophthalmic clinic was built.