Notre Dame Honors PIH

	Paul Farmer and Ophelia Dahl speaking at the University of Notre Dame.

During two decades in various leadership roles at Harvard University, Steve Reifenberg worked closely with Partners In Health co-founders Ophelia Dahl and Paul Farmer as both colleagues and friends. Recently he had the chance to reflect on their mission to deliver healthcare to the world’s poorest people while presenting PIH with the Notre Dame Award for International Human Development and Solidarity.

The award – presented to Dahl, Farmer and Loune Viaud, director of PIH’s sister Haitian project Zamni Lasante, on behalf of thousands of workers in 11 countries – recognizes individuals and organizations that stand in solidarity with those most in need.

“There is a magical presence of watching someone do what they love doing and with joy,” said Reifenberg, who now serves as executive director of Kellogg Institute of International Studies. “Paul and Ophelia and Loune are really good – there is that same magical presence and you see that joy in their faces and in everything they do when you watch them at work, and it is just like watching a great conductor, dancer or musician perform.”

Beyond individual praise for the organization’s leadership, Reifenberg said it was the story of PIH as an institution that was most compelling. From his experiences at PIH sites around the world, he came to appreciate three key ways that PIH succeeds: “expanding our sense of the possible, creating models of institutional innovation and rethinking our concept of charity,” he said.

Reifenberg offered two stories to illustrate his own experience with PIH’s impact:

Accompaniment in Peru
I spent the time in Lima with Socios en Salud – that’s Partners In Health in Spanish – with country director, Jaime Bayona, some of his colleagues, and a community health worker, Ana, who had formerly been a TB patient. She is part health worker, part social worker. I spent the afternoon doing what Ana does every single day, climbing up and down the dusty hills of Caraballyo. She does it every single day, because if you’re a TB patient, as she had been, she needs to insure you don’t miss a treatment. 

Ana was welcomed into homes like a neighbor or an old friend. Seeing Ana, it seems, was the highlight of the day for many people at home with TB. During her visits, she not only watched the person take the medication and talked knowledgeably about TB drugs and prevention, but she also engaged in conversations about daily life ranging from counseling what to do with a misbehaving teenager (be patient) and what to do about an errant husband (don’t be so patient).

There are remarkable 99% compliance rates for taking the drugs daily, and it’s a story about community health workers connecting their lives with the people they are visiting daily.

Ana is not unlike thousands of other PIH community health worker colleagues in Haiti and Rwanda and elsewhere who might have only a few years of education, and have very likely been patients themselves. Nearly two thirds of 13,000 people working for PIH around the globe are community health workers. They now have jobs, which in and of itself is transformative, and they in turn, through their work transform the lives of others.

Ultimately this model, led by Socios en Salud and PIH in the dusty hills of Caraballyo, required international organizations to rethink what is possible – and effectively, the WHO changed its standard protocols that now recommends treating MDRTB patients in all parts of the world, including the poorest.  So Ana and thousands of other community health workers like her begin to help us imagine and expand the sense of what is possible.

Healing in Haiti
Reifenberg wrote about his experience with accompaniment in a January 8^th, 2002 journal entry following his visit to patients at Zanmi Lasante:

We are told that there is a party for Charlene who has been a patient at Zanmi Lasante for the last year. The square room that serves as meeting hall, conference room, and chapel  – is now decorated with crepe paper streamers as the “party room.”

There are about 15 patients seated around the perimeter of the room. A few of the Haitian patients smile or nod to us, but most just sit in their chairs, as our group comes in. It is apparent that the guest of honor, Charlene, is the woman wearing a pink and blue dress, and coral colored sandals.

Charlene sits in the center of the group, and although she doesn’t speak to anyone, she has an enormous smile on her face. Things seem quite somber, with the exception of Charlene who continues to smile at everyone. We say hello to a few people and nod, and then also sit quietly, waiting.

Two Haitian doctors, including Dr. Jermore, the head physician, and Paul Farmer come in, and everyone lights up.  The doctors greet each patient by name and converse in Creole.  Paul then turns to us in English.

“There is a party every time someone who has had an extended stay at the hospital is able to leave and is able to walk out of the hospital healthy… or at least a lot healthier than they were when they arrived...”

The doctors turn to Charlene. She beams.

“Charlene tells us about your story,” Paul says, “so we can all celebrate your health.” This is obviously the moment that Charlene has been waiting for.

“When I arrived at Zanmi Lasante, I was hardly able to walk,” Charlene says. “I had chills, and so much pain it was as if giant snakes were in my stomach. When I came here, I took many medicines. The doctors and nurses took very good care of me.”  She tells of specific moments of kindness, someone who brought her a fresh juice, a nurse who carefully helped her move when she could not do so herself.  “The Partners In Health doctors saved me.”

By way of conclusion she says, “I apologize that at this party, I have no gift I can wrap in a package for you. But please – my doctors, friends, and visitors” – she says, pausing, looking at each of us, “my story is my gift, and I give it to you with no wrapping, but with all my heart.”

This moment defines accompaniment. Charlene gives the great gift of her health and her story, and we each share what we can, and we are transformed in the process.