A PRESCRIPTION FOR 1 BILLION PEOPLE: GO THE LAST MILE
October 10, 2013
PARTNERS IN HEALTH (PIH)
PARTNERS IN HEALTH (PIH) -with Budapest's special correspondent for EconomistEurope.com
DIARY OF WHOS MOST EXCITING YEAR IS 2015
Millennials POP: PIH culture is designed round Franciscan values (celebrations Dc September, Peru October)
-RESOURCES AND MILLENNIALS NEXT SOCIAL MOVEMENT
two sustainability world teaching hospitals -mirebalais haiti, coming soon Rwanda (pih is jewel in crown of kagame's national strategy)
asia millennials how can asia pacific link in its pih millennials -map needs japan, korea, china to start
africa millennials :will legacy of ebola be enough african nation leaders wanting to partner pih rwanda (more headlines economistafrica)
probabilities- jim kim has capability post 2018 to keep asia on track
-africa wont get on track unless open education revolution works on this agenda
what EconomistAmerica knew in 1984
weatern millennials cannot sustain
4000 times more spend on global commns (2030
versus 1946) unless basic universal health becomes 10 times more
economical for youth and parents of youth
the way open education is designed will determine
worldwide sustainability of millennials
what's knowable in 2015
Longer farmer videos 57.30 farmer starts here from minute 29 gies back to why he adopted liberation theology and haiti and trying to understand violence *and farm slavery) in central america in early 1980s
shorter pop 3.19
xMIREBALAIS : New hospital in Haiti proves that aid done right can change lives
Jim Kim alumni networks include: specific to farmer and Partners in Health up to 2012; selected tour of world bank panelists with jim kim; tedx alumni with jim kim; larger compass of world bank live eventsand webinars -coming soon more details on world bank open learning campus
Philosophy of Farmer and Francis
I suggest that if any economist from adam smith to keynes came back to earth and looked at what conventional macroeconomists have spun since world war 2 and tv era , they would not recognise what was going on in the name of economics. If there was an oxford union debate on this house believes macroeconomists 1948-2008 became experts in designing the most costly systems on earth, how would you vote?
Despite unprecedented new financial resources and medical advances during the past decade, millions of people are still not receiving quality health care in poor countries around the world. Health...see more
At PIH’s Fifteenth Annual Thomas J. White Symposium in 2008, a young man from Burundi took the podium. “The fight for global health has started,” he told the rapt audience. “And it won’t be won if only one organization like Partners In Health is in the running, without [other organizations] branching off. It will be won by an army of compassionate people who think globally like PIH people.”
The movement to provide a preferential option for the poor in health care continues to grow, and it wouldn't be possible without the following organizations, which are working with local communities and governments to create change. Partners In Health is proud to count these groups as Partner Projects, projects that are working to implement the PIH model across the globe.
El Equipo de Apoyo en Salud y Educación Comunitaria (EAPSEC, The Team for the Support of Community Health and Education) was established in 1985 by a small group of Mexican health promoters. Over the past two decades, the EAPSEC has partnered with dozens of indigenous and rural communities throughout Chiapas to develop local health capacity.
Equipo Técnico de Educación en Salud Comunitaria (ETESC, Technical Team for Education in Community Health) is a community non-profit that seeks to revitalize and repair the social fabric in Huehuetenango, Guatemala. Strategies for structural and care-based change include legal accompaniment, health care access and promotion, and HIV education for students.
Through our partnership with Justice Resource Institute, the Boston-based PACT Project serves HIV patients and provides technical assistance to other health care organizations. The PACT project transitioned to JRI Health, a division of the Justice Resource Institute, in July 2013. One of the largest human service agencies in Massachusetts with more than 40 years of experience, JRI continues serving PACT’s Boston-area patients while devising ways to implement similar health care programs across the United States.
Possible is a nonprofit healthcare company that delivers high-quality, low-cost healthcare to the world’s poor. Possible is pioneering a new approach, called durable healthcare, that brings together the best of private, public, and philanthropic models. Since 2008, Possible has treated over 167,000 patients in rural Nepal through government hospitals, clinics, community health workers, and a referral network.
Muso Ladamunen (The Project for the Empowered Woman) aims to solve health crises at their roots by addressing and transforming the violent conditions of poverty and gender inequality that cause disease. Project Muso integrates health care delivery with microfinance, community organizing, and participatory education programs in Yirimadjo, Mali.
We are seeking a motivated design professional with a talent for creating current and beautifully designed visual content, online and offline. Muso is going through an exciting period of growth. We are looking for someone who can visually present Muso’s work in a way that communicates our groundbreaking impact, tells the story of our model, engages global partners to catalyze Muso’s scale-up, and accelerates efforts to save millions of lives. We need those we engage to connect with people they have never met before, understand the transformative impact they can make, and become inspired to take action. The Creative Director visually tells the story of our purpose, our model, and our impact, of the change that is possible for us to create together with the global community. The Creative Director will also work closely with the Director of Development and Communications to ensure that Muso’s message is powerfully and regularly communicated to the broader public by participating in online communications and social media. Click HERE to apply.
Director of Development and Communications
We are seeking a motivated development and communications professional with exceptional writing, organizational and people skills. Muso is going through an exciting period of growth. We are looking for someone who can effectively communicate Muso’s purpose, elevate our profile and raise resources to help meet our ambitious goals. This critical member of our team will create, lead, and implement our development strategy, mobilize the resources and partnerships for Muso to rapidly grow our impact and provide life-saving care to hundreds of thousands of people, and to establish a model for saving millions of lives. Although this is an all-encompassing development role, there is a particular emphasis on developing proposal submissions, requiring exceptional writing skills as well as attention to detail. Click HERE to apply.
Last Mile Health, known as Tiyatien Health in Liberia, saves lives in the world's most remote villages by recruiting, training, and supervising high-performing community health workers. Last Mile Health currently works in Grand Gedeh County, Liberia, and plans to scale its innovative Frontline Health Worker model to 10 additional health districts by 2017 in partnership with the Liberian Ministry of Health.
Wellbody Alliance trains community health workers to reach patients in Kono District, Sierra Leone. The organization also runs primary care clinics to meet the needs of the community for maternal health, child health, the prevention and treatment of HIV/AIDS, and chronic disease management.
Village Health Works was formed to bring high-quality health care to the rural Burundi community of Kigutu, as well as to address the root of the village's poor health--poverty. The Kigutu Health Center provides clinical services to the community, focusing on primary care, pediatrics, and women's health.
If there is anything social entrepreneurs and investors attending the upcoming Opportunity Collaboration have in common – it’s courage. Courage has shaped our work at Last Mile Health. Courage has also shaped my own family.
In the 1970s, my parents emigrated from India to Liberia, a West African nation founded by freed American slaves, where I was lucky to be born. We loved Liberia. Its unparalleled beauty was matched by its opportunity. My mother found work as a tutor in Monrovia and my father launched a small general goods store.
But, in 1990, when I was 9 years old, rebels launched a civil war. In just a few weeks we lost everything – our home, our way of living, and when my father went missing for a month we thought we had lost him too.
But, we were the lucky ones. We all escaped and we all survived, my father included. With the help of many Americans, we rebuilt our lives in North Carolina and I followed my dream to become a doctor. But, I never forgot where I came from. Liberia had a lit a torch in my heart and the generosity of Americans who helped us had ignited it. So, eight years ago, I returned to Liberia as a 24 year-old medical student, to help serve the people I had left behind.
What I found was utter destruction – and not just empty shells where buildings once stood. To serve the remaining 4 million people, Liberia was left with just 51 doctors (there were more doctors in my single residency class at Harvard). If you fell sick in a city where the few remaining doctors worked, you would stand a chance. But, if you fell sick in remote villages hundreds of miles away from the nearest clinic, you would die anonymously.
Imagine not living in a city like San Francisco, New York, or London, where a clinic might be around the corner or a short drive away. Imagine, instead, living in an isolated rainforest village and your two-year old son has woken up one morning with a fever. You panic, because you know he likely has malaria and the only way to get your son the medicines he needs would be to carry his frail body on your back, paddle a canoe across the river, then hike for up to two days over log bridges and across the mud in the jungle before reaching the nearest clinic.
It’s an impossible situation. Yet, this isn’t just the story of one mother and one child in one far-off village. Around the world, 1 billion people lack physical access to medical care because they live in remote, last mile villages — too far from the nearest clinic.
The standard solutions — constructing more clinics and deploying more doctors –are necessary, but they are not sufficient: they still haven’t reached last mile villages. Rebukes like it’s “too expensive”, there “isn’t enough infrastructure” and “it’s too far away”, create a suffocating cynicism that plagues health care delivery in the world’s most remote villages
It’s no wonder most don’t dare to go the last mile and why many experts told us not to dare trying either.
But, we chose not to listen. Deep in Liberia’s rainforest, my colleagues and I discovered new opportunity embedded in an old idea. We created Last Mile Health to saves lives in the world’s most remote villages by employing community health workers and giving them all the inputs — training, equipment, and support — they need to perform.
The idea of community health workers is not new. In villages where doctors and clinics don’t reach it has been thought, for at least a few decades, that community health workers – training a local villager to provide basic health care – can save lives.
But, community health workers, at least in their conventional form, too often fail. It’s not their fault. Too many health systems still underinvest in community health workers and therefore they underperform – especially in remote areas.
Let me explain. When deploying a community health worker, the status quo has been to ask a chief in a remote village to select a community member, like Zarkpa, who never finished middle school and never had a job. Without testing if she’s qualified, Zarkpa would be trained for a few days to be a community health worker and then, basically left to fend for herself – unequipped, unsupervised and unpaid.
In effect, she’s treated like an amateur. Zarkpa (and thousands of other community health workers) never reaches her full potential and neither does the health of her village. Village women and children, who have never had primary care, never get it.
At Last Mile Health, we do things differently – not with medical innovation, but entrepreneurial creativity. We make each of the five processes needed to deploy a community health worker – recruiting, training, equipping, managing and incentivizing – more efficient and more effective. In so doing, we transform community health workers from under-performing amateurs into high-performing professionals — strengthening the rural health system.
Here’s how we get it done. Before Last Mile Health recruited her, Zarkpa had to pass four tests, including being vetted by her community, passing a literacy screen, two practical assessments and a probationary period — to make sure she was qualified for the job. We trained her, not for a few days, and not only to educate her community to prevent a few diseases, but for sevral weeks to provide prevention AND diagnosis, treatment, and referral services for the top 10 killers of women and children – so she can play an vital role in fighting the majority of disease killing her people.
Then, we equipped Zarkpa with a backpack full of point-of-care tests, like a hand-held test that diagnoses malaria within a minute, and life-saving medicines, like antibiotics; assigned her anoutreach nurse who rides a motorbike out to Zarkpa’s village and coaches her every week – so she continually improves her skills and patients too sick to treat in the village get referred safely; and gave her a paid contract, tying it to her performance – so she’s accountable to the people she serves.
In short, Zarkpa’s not treated like an amateur. With the right inputs, she’s treated like a professional (just like any of us would want to be). And, she performs like one. Zarkpa has mastered over 50 medical skills: she can diagnose and treat children with malaria and pneumonia, screen women for anemia, HIV/AIDS, and high blood pressure, and identify complications of pregnancy and childbirth.
Even professionalized community health workers are not a panacea. But, when integrated with the health system, this work – giving community health workers everything they need to do their jobs well – saves lives in places never thought possible. We launched Last Mile Health from a bombed out building in Liberia’s rainforest in 2007 with $6000 in donations collected at my and my wife’s wedding. Today, partnering with the Liberian Government, we’ve performed over 70,000 patient visits and in the most remote district – Konobo – we have tripled access to care. Today, five times as many children get vaccinated. Today, twice as many children with malaria get treated and all pregnant mothers receive care. And today, that mother no longer feels the panic of not knowing whether she will be able to tow her feverish son to the clinic before it is too late. She and her son have real care right at their doorstep – where it can have the biggest impact.
We could not have come this far without our partners. Our challenge now is to scale-up and go the last mile. There are still 1.5 million people in remote areas of Liberia, and yet millions more around the world, who go without access to care.
We have a plan to start changing that. Earlier this summer, at the Forbes 400 Summit on Philanthropy at the United Nations and subsequently at the Clinton Global Initiative, we announced a 3-year plan with Liberia’s President Ellen Johnson Sirleaf to deploy300 professionalized community health workers to bring access to care to 150,000 people who’ve never had it. Not only will this create a medical safety that saves lives, it will create jobs – 300 of them – in a country where rural employment is 85%.
We invite those who share this vision to join us in accelerating progress towards these goals.
As a physician who has had the privilege of caring for the sick both in the villages of the country I escaped from and in the cities of the country I escaped to, I know one thing is true: illness is universal, but access to care is not. I also know we can change that. By pairing the best of medical care with the best of social entrepreneurship, there is no challenge we cannot overcome – not even the challenge of bringing quality health care to each and every corner of our planet – if we find the courage to go the last mile.
help us post million postcards
Posters of particular interest fromboston global health conference
Posters of particular interest today:
Improving nursing and midwifery clinical education by developing local faculty mentoring capacity in Malawi
By JL Holman, M Muyaso, G Msiska, D Namate, R Wasili, S Jacob
Expanding medical and nursing educational experiences in Haiti: A partnership learning
By E Dupont Larson, M Nadas, C Louis-Charles, M Gideon, P Gaetchen, M Trouillot, C Curry
Evaluating the impact of a nursing assistant training program in rural Uganda
By M Sadigh, J Sarfeh, R Kalyesubula
Strengthening nursing workforce: A key ingredient for achieving PEPFAR HIV prevention, care & treatment priorities
By S Strasser (ICAP)
Evaluating the developing families center: A unique model of midwifery care, primary care and early childhood education
By M Furrer, LJ Hart
Applying classical learning theories to quality improvement interventions among mid-level providers in Kenya
By S Onguka, RR Korom, P Halestrap, M McAlhaney, MB Adam
Results of a five-year program review for the first U.S.-based masters of science in global health at UCSF
By K Baltzell, M Dandu
Training leaders in global health: The global health delivery intensive (GHDI) program at Harvard University
By A Campbell, K Wachter, J Rhatigan, M Smith-Fawzi, R Weintraub
The global health leadership track: Collaborative training for future leaders in global health
By J den Hartog, R Dillingham, F Hauck
Global health preparation and reentry modules: An innovative, interactive, online, open-access, modular curriculum for global health rotations and projects
By GA Jacquet, J Tupesis, M Rybarczyk, MM Fleming, S Gadiraju, et al
E-mentoring is effective and cost saving in resource limited settings
By T Pollack, V Tuyet Nhung, D Nhat Vinh, N Thanh Liem, N Hieu, P Le An, L Cosimi
A curriculum and assessment tool for point of care ultrasound training in limited resource setting
By S Shah, C Reynolds, D Mantuani, J Uwamungu
REW - re-entry workshops: supporting students to integrate their global health experiences upon their return
By J Sherman, I St-Cyr, J Tuck
UpToDate-GHDonline collaboration: Increasing uptake and access
By R Weintraub, S Bhandari, E Baron, J Daily, P Bonis
Examining ourselves: Who does global health research really serve?
By JJ Wilson, LD Wilson
Implementation of low-cost, point-of-care cardiovascular diagnostics by non-healthcare professionals in rural Uganda
By J Kim, LC Hemphill, Y Boum, DR Bangsberg, MJ Siedner
A Discussion on the inclusion of minorities and underserved populations in global health workforce
By V Duru, P Adkins-Jackson
Reasoning without resources: A teaching case series from rural Uganda
By G Fung-Chaw, N Murakami, A Patel, T Leupp, D Morris, G Paccione
health microfranchise catalogue\-world benchmarks (NB please go to microfranchisetrust.comif you are searching for sustainability bankers- ie those collaboratively owning maps of many win-win microfrachises)
W4EHM - curriculum of diarrhea- microfranchise of oral rehydration- sustainability world's first grassroots networks of Women4Empowerment
hm0 aravind end unnecessary blindness
hm1 batra specialty :end tuberculosis on indian continent contrast with this being major innovation offer of full services like brac and partners in health and medecins sans frontieres (aka doctors without borders)
3 last mile heath networks west africa
4 grand orchestra of xmas poland, social solution winner at 2013 nobel peace laureate summits
some special youth microfranchises
Eva Vertes -innovation circle for cancer
log for aravind
Aravind - a franchise for ending unnecessary blindness by designing most economical way of delivering cataract surgery is a beautiful system design
Larry Briliant is one of health's 10 greatest living heroes; in the pre-digital days he was there to end smallpox on the indian continent; in the 2000s his wish t develop mapping tools to help end plagues and other borderless risks was celebrated with a ted prize which also led to larryb being the first ceo of google.org
but in this beautiful description by Larry of the founder of aravind- why cant open source local franchises be designed as effectively as mcdonalds, Larry doesnt give all the details -out of modesty one of the things he forgets to mention is that his greatest medical network linked in opticians without borders who helped founder of aravind with quite a lot of the technical knowhow
moreover since the death of the founder of aravind, his franchise has been adopted -and it has lived up to the promise of being so well documented that it is replicable beyond borders- what's missing is knowledge envoy of aravind as a microglobal brand identified with such joyful replication - so eg when yunus started replicating it there is no credit to aravind making it hard for students to understand where the knowhow of grameen eyecare came from
shelly batra's wonderful franchise (network) for how to sustain end of tuberculosis through community healthcare training and delivery on indian subcontinent can be seen at theworld bank tedx of 2014
we have also arranged for her to be freely beamed down from 5 billion person elearning satellite yazmi.com
diary correspondence april 2015 between millennials health asia and batra
Dear Bhim,Good to 'meet' you. My organisation, Operation ASHA ( www.opasha.org) has been focussed on TB eradication, but serving the needy at all times is very much our focus. I have been to kathmandu several times, and now these heart breaking stories in the media have moved me to tears.let me know how I can be of help. I am based out of New Delhi. Should I send you non perishable food items, blankets etc for distribution? Do you need assistance in post-quake infection control, ie prophylaxis of water & food borne diseases?
Please join the Global Nursing Caucus for a special Nurses Week event :
Nursing Leadership in Global Health
May 12, 2015 - 5:30pm-7:30pm
The event will take place at the offices of Partners In Health (3rd Floor, 888 Commonwealth Avenue, Boston, MA 02215). The event includes two important speakers, opportunities to network with our colleagues and light refreshments.
Maggie Sullivan, RN, MS, FNP, BC https://www.ghdonline.org/users/maggie-sullivan/ will be speaking about her experience as the moderator of GHDonline - Nursing and Midwifery page.
Pat Daoust MSN, RN, will be speaking about her experience with SEED Global Health and MGH Global Health program.https://giving.massgeneral.org/global-health-malawi-daoust-nursing/
Please feel free to share with colleagues and other nurses interested in the important role of nurses in promoting health locally and globally.
---------------What WORLD WOULD MISS WITHOUT LEADERS OF PARTNERS IN HEALTH
Without Paul Farmer there would be no PIH (and no hope that poor's or your medical world will ever get less expensive? nor any demonstration that muslim and catholic peoples the world over love public health servants)
We suggest every sustainable member of the net generation needs to know about medical world's most dynamic duo Paul Farmer. How they have changed global social value of health need parallel youthful change-world networkers in every profession and practice that can serve a life-changing purpose.
Both Paul Farmer whose family lived on a run down boat in Florida, and Jim Kim whose family were refugees from North Korea living in mid-America, had unusual childhoods. From quite an earl age they turned not being conventional social stereotypes into relentless scholarship - first anthropology and then medical. By around 1982 Farmer had graduated in anthropology from Duke U, spent a year in Haiti asking himself how could I be most useful to the poorest people here and decided he better study medicine at Harvard. This he appears to have done by commuting between haiti and boston. His practice experience with haiti's poorest was so uniquely knowledgeable that his harvard professors couldnt mark him down. By 1987 Farmer had about 5 years experience on ministering to his rural practice in Haiti and having qualified as one of the best in class, he won the 6-month a year post of leader of ID (Infectious Diseases) at Brigham Womens Hospital in Boston leaving him 6 months for his passion serving poorest in rural Haiti. At about this time he met Jim Kim and Partners in Health was formed with these two leading the medical knowledge exchanges.
Lesson 1 is How They Twinned Boston and Haiti and soon tripled up with PERU. From the formation of PIH the culture was Preferential Option Poor POP)- ie serving health to the poorest by living with them. POP (longer learning modules at kimuniversity.com) was actually an ideology that had linked together a lot of Catholic South/Central America's deepest servant leaders starting in late 1960s notably around Peruvian Gutierrez (rooted all the way back to Franciscan was in 1210)
Having introduced videos of Kim and farmer- we hope you can see why we recommend that one of them is featured anywhere that people lpay the 12-person game of world record job creation. (So as to maximise different dimensions of job creation, whenever we play a top 12 game in relation to 2 people whose links are map as closely as Framer and Kim we only choose one of them. Usually when we play the game we choose Jim Kim because since 2012 as president of world bank he has started to bridge another mission impossible- from poor persons practice servant leader to being integral to the biggest projects and partners decisions in developing world bank). But note where we map round Kim we never forget that when it comes to health service accompaniment with the poor, Paul Farmer is unique in the world today