PIH In Peru: 25 Years of Growth, Transformation

A quarter of a century ago, in the hillside communities of Carabayllo, Partners In Health dared to pursue a simple yet radical idea: no patient should die because a disease was considered “too expensive” or “too complicated” to treat.

That was exactly what the global health community had decided about multidrug-resistant tuberculosis (MDR-TB) in Peru in the 1990s, even as a deadly outbreak tore through Carabayllo, an impoverished community on the outskirts of Lima. And it was a status quo that PIH refused to accept.

As case after case of MDR-TB was uncovered there, PIH Co-founder Dr. Jim Yong Kim, Father Jack Roussin, a PIH friend and partner, and Peruvian colleagues came to realize that a solution was urgently needed—one that put Peruvian clinicians and communities at the center of the work and that upheld not convention, but justice.

On July 8, 1996, Socios En Salud was born.

In the 25 years since, Socios En Salud, as PIH in known in Peru, has not only triumphed in the face of MDR-TB—treating more than 10,500 people for the disease and achieving a cure rate of 83%, among the highest in the world—but also provided a time-tested model for what it means to work alongside local communities by delivering lifesaving medical care and essential resources, training the next generation of clinicians, and strengthening health systems before the next crisis hits.

As Socios En Salud’s decades of care and service demonstrate, injustice has a cure. A better world is possible—a world where health care is not a privilege, but a human right.

Below, a curated collection of photos tells the story of Socios En Salud, then and now—from its beginnings during the deadly MDR-TB outbreak to its leadership amid the COVID-19 pandemic.

PIH Co-founders Dr. Paul Farmer, Dr. Jim Yong Kim, and Ophelia Dahl worked closely with Peruvian leaders, including Dr. Jaime Bayona, former executive director of Socios En Salud, as the newly-formed organization responded to multidrug-resistant tuberculosis in Carabayllo in 1996. Farmer, Kim, and Dahl had begun their work in Haiti just years earlier, establishing a clinic in Cange to provide free health care to rural communities there and laying the groundwork for PIH, which was founded in 1983. In addition to calling for global health equity amid the MDR-TB outbreak in Peru and helping change WHO protocols for care, the team would go on to help lead the global health response during the early years of the HIV/AIDS epidemic—stories captured in the critically acclaimed documentary Bending The Arc.

Dr. Jim Yong Kim, PIH co-founder, stands with Peruvian children in Carabayllo, an impoverished community about 20 miles north of Lima, where Socios En Salud has worked for a quarter of a century. Carabayllo has a population of 321,752 with more than 23% of residents living in poverty. Socios En Salud’s decades of work there has strengthened the community’s health system and improved quality of care and access for thousands of patients and their families.

In the years since the MDR-TB outbreak, Socios En Salud has expanded its programs to clinical areas ranging from mental health to child health. It has also continued to provide social support, such as food and housing assistance, to Carabayllo’s communities, where poverty is so severe that just one missed paycheck can threaten a patient’s day-to-day survival and access to medical care. Social support is based on the idea that social and economic factors—not just medical—impact a patient’s health and that treating the whole patient—not just their illness—is essential to care delivery. In this photo, Hildo Miranda, a health promoter with Socios En Salud recruited by the late Father Jack Roussin, carries food supplements through the streets of Carabayllo in 2001.

Through the years, Socios En Salud has continued to set new standards for tuberculosis care, providing medications, screening, and support for thousands of patients in communities where treatment of the disease was once thought impossible. Socios En Salud’s tuberculosis program includes innovative interventions such as Backpack TB and TB Móvil, which sends vans equipped with rapid tuberculosis testing into Carabayllo’s remote hillside communities. Peru is also part of the endTB project, which PIH is co-leading to discover shorter, less toxic, and more effective treatments for drug-resistant TB. Since 2015, the endTB team has brought two new drugs to 17 countries burdened by MDR-TB and is completing two large clinical trials, with the goal of finding treatment regimens with better than 80% cure rate. In this photo, Dr. Epifanio Sánchez, a physician with the Ministry of Health at Sergio E. Bernales National Hospital, tends to a tuberculosis patient in Carabayllo in 2017.

To accompany patients through Peru’s health system, Socios En Salud enlists the help of dozens of community health workers, known locally as agentes comunitarios de salud. These community health workers are hired from the communities they serve and trained to deliver medications, social and emotional support, and basic health services through house calls and accompaniment to and from medical appointments. In this photo, Community Health Workers Inela Espinoza (right) and Dina Gomez (left) walk through San Gabriel, Carabayllo, after conducting a training session for caretakers and mothers in May 2016.

For years, Socios En Salud has worked with Peru’s Ministry of Health to improve infection prevention and control measures in Lima’s prisons, where incarcerated people are especially vulnerable to MDR-TB and—now—COVID-19. In this photo, Dr. KJ Seung, an infectious disease expert with PIH, and Dr. Joia Mukherjee, PIH’s chief medical officer, join tuberculosis experts from PIH, Socios En Salud and the Ministry of Health on a tour of a prison in Lima in September 2016, where a high incidence of MDR-TB pointed to the urgent need for care and support. Over the years, Socios En Salud has screened dozens of incarcerated people for TB, uncovering previously undetected cases, and has provided specialized care in 30-bed isolation and treatment rooms.

As the COVID-19 pandemic strained Peru’s health system and put marginalized communities at risk, Socios En Salud was ready to respond, bolstered by its decades of experience responding to tuberculosis and other diseases in Carabayllo. Over the past year, Socios En Salud has conducted COVID-19 tests for more than 41,330 people, with 18,066 testing positive. To counter the financial burdens of the pandemic, Socios En Salud has provided 1,605 families with food vouchers and 1,679 with socioeconomic support. Throughout its pandemic response, Socios En Salud has not only cared for COVID-19 patients but has also continued its lifesaving clinical programs for chronic disease patients—ensuring access to high-quality health care even in the most dire times. In this photo, Genaro Anco, coordinator of the social protection program at Socios En Salud, delivers cleaning kits to prevent the transmission of COVID-19.