For those of you who don’t know, PIH has been a pretty influential organization in the Health World. Its charismatic co-founder, Paul Farmer, is working with Bill Clinton to be a Special Envoy to Haiti (whatever that means, but it sounds important). They have treated patients all over the world, in areas that, because of geographic isolation, were once thought impossible to reach. They now work in 11 countries around the world.
Probably their first large-scale policy change came in their treatment of multi-drug restistant tuberculosis (MDR TB) in the mid-nineties. The World Health Organization’s (WHO) official stance on MDR TB was that it was not cost effective to treat, and did not pose a major threat (potentially because those who had MDR TB were dying without treatment).
PIH’s contacts in Peru begged to differ. They knew many people with MDR, and they knew it was spreding rapidly throughout the marginalized areas of Lima. So they went about studying and treating a group of people with MDR TB, the largest cohort ever treated up to that point: 10 patients. And they found cure rates better than those in the United States. They were able to barter with drug companies to lower the prices of MDR TB drugs and, in 1998, change the WHO’s policy on MDR TB. Furthermore, they have been working with Peru’s Ministry of Health to have them adopt their MDR TB treatment program nationally. In March, PIH in Peru held the a week-long conference training the WHO in TB treatment.
Yes, so they’re kind of a big deal. But the idea behind their success is not revolutionary. They use community health workers. What that entails is training members of the community to visit patients, make sure they take their medicines, and provide them with support. This idea works so well because these health workers have either been patients in the past, or have had someone close to them who has had to get treatment for TB. They know what it’s like to take medicine every day for 6 months, or in some cases of MDR TB, a year and a half. They know what the patients are thinking and feeling. They know what the community needs and have ideas how to help with that. They know it’s worth it to treat patients. They are not doctors, nurses, or statisticians from outside, but people who have grown up their entire lives walking the same streets that they walk to visit patients. They can’t meander five minutes through the community without getting stopped and asked for help. And they do help. It is because of this community-feedback mechanism that PIH has developed it’s mission of integrative health, a topic which I will touch on next week. But just so you know, these big policy changes and idea shifts did not come from Paul Farmer, they came from people in the community.
