Health as a Human Right Partners In Health Cory McMahon, BSN RN Nurse Educator Partners In Health

"The worst sin towards our fellow creatures is not to hate them, but to be indifferent to them: That's the essence of inhumanity." George Bernard Shaw George Benard Shaw

Human Rights Approach to Health A human rights approach to health is critical to address growing global health inequalities. London, L.. What is a human rights-based approach to health and does matter?. Health and Human Rights: An International Journal, North America, 1013 06 2008. “Everyone has the right to a standard of living adequate for the health and wellbeing…including food, clothing, housing and medical care and necessary social services” Universal Declaration of Human Rights, article 25 (1948), New York: United Nations.

Health Inequities Today more than one billion people cannot obtain the health services they need, because those services are either inaccessible, unavailable, unaffordable or of poor quality. Widening inequities across the world mean that an estimated 100 million people are pushed into poverty every year when they pay out-of-pocket for health services. These problems are of systemic nature and require an all-encompassing approach.   World Health Organization

25 Years of Innovation & Impact PIH is an international health organization relentlessly committed to improving the health of the poor and marginalized. We bring the benefits of modern medical science to some of the world’s poorest communities and serve as an antidote to despair.

PIH Worldwide We provide healthcare for nearly 3 million people We have built or renovated and currently operate 60 health facilities across 12 countries We employ nearly 14,000 people around 100 are Boston-based >9,400 live in settings of extreme poverty, and include nearly 7,000 accompagnateurs

Our Approach We work in some of the poorest, most remote, most marginalized communities. We tackle diseases and conditions others have deemed intractable, or too expensive and complicated to treat. We partner with the communities we serve, build local capacity and support the public sector to develop innovative, scalable and sustainable solutions. We work in some of the poorest, most remote, and most marginalized communities. We tackle diseases and conditions other have deemed to difficult to treat. This means we are constantly questioning our assumptions about what works and what doesn’t, and pushing ourselves to innovate. We document our work, measure its impact and make changes when necessary to improve the quality of our programs. Our work falls primarily into four categories: 1- Deliver high quality healthcare 2- Overcome barriers to good health 3- Strengthen health systems 4- Link modern medical science with some of the world’s poorest communities

Health Inequities: National Health Statistics

Health Expenditures

Accompaniment “To accompany someone is to go somewhere with him or her, to break bread together, to be present on a journey with a beginning and an end… Accompaniment is about sticking with a task until it's deemed completed, not by the accompagnateur but by the person being accompanied” --Paul Farmer

We began in Central Haiti Cange, 1985 We started very small, in squatter settlement in rural Haiti. This is a picture from the very beginning – it looks much different now. Today, Cange is a bustling medical center, with operating rooms, a blood bank. There are so many trees you can barely see the buildings. But in 1985, Cange was a community of refugees – people who had been displaced by a hydroelectric dam that wiped out their homes and all the good farmland. The communities where we work are the poorest of the poor; we work with people who are marginalized because of illness or poverty, people who are forgotten, people who have no voice.

Haiti

Haiti - Now

HÔPITAL UNIVERSITAIRE DE MIREBALAIS (HUM) 180,000 sq feet facility 6 Operating Rooms Maternal Child Health—250+ deliveries per month Specialty Areas Surgery, Oncology, Mental Health, NCD’s, Neurology, NICU 3 MD Residency Programs started Oct 2013 Surgery, Pediatrics, Internal Medicine CRNA program starting Winter 2014

Structural Violence “Inequity that is nobody’s fault, that is just the way things are, that we live with because we cannot or will not or do not know how to address the conditions that create unequal outcomes for rich and poor.” Paul Farmer

Socialized for Scarcity If you have Breast Cancer and are born in rural Rwanda– you will probably die. It is normal for women to die during childbirth in Lesotho. Street violence is normal in Mattapan. Children die of malnutrition in Haiti. We can’t help, we have problems here at home.

Misconceptions: Foreign Aid Spending % of budget that Americans… PIPA Federal Budget Poll Source: WorldPublicOpinion.org (November 30. 2010)

World Military Spending and Foreign Aid 2008 US Billions Center for Arms Control and Non-Proliferation and OECD 2011 defense budget: $719 B Source: Center for Arms Control and Non-Proliferation and OECD

High Quality Health Care We deliver high quality, comprehensive medical and nursing care to people living in poverty: Infectious disease Primary care Maternal and newborn health Chronic diseases Mental health Rehabilitative medicine Surgery We successfully treat infectious diseases like tuberculosis and HIV and malaria. We provide primary care services. We perform surgery. We tackle maternal mortality and malnutrition, cancer, heart disease and other conditions of ill health. We strive for a world with equity in health care and for communities with zero preventable or “stupid” deaths. We strive for a world with zero preventable or “stupid” deaths.

Treat infectious diseases e.g. TB, MDR-TB, AIDS/HIV, malaria, cholera Share an infectious disease anecdote – e.g. MDR-TB Treat infectious diseases

Provide our patients access to primary care services, like vaccinations, regular checkups and antibiotics when they get sick. These are basic services that keep people well, help identify disease in early stages before it becomes deadly. Primary care

One thousand women die every day, 365,000 each year, from complications associated with pregnancy and childbirth. In many of the countries where we work, as many as 1 in 15 women dies in childbirth. We provide women in the communities we serve access to basic care – regular checks ups, including papsmears, breast exams and cervical cancer screenings, family planning services, pre and post natal care, a safe place to deliver their babies (in clinics) and increasingly, access to emergency obstetric care such as a cesarean section or a blood transfusion, to save women’s lives. Maternal health

Cancer Treatment Almost 80 percent of the global cancer burden occurs in low- and middle-income nations, yet those countries claim only 5 percent of the global spending on cancer.

The impact of the diseases cannot be separated from the socio-economic context in which they develop. “there is no more place in this country than in any other for self-congratulation on the quality of the medical care that has been developed until the utmost has been achieved in making it available to alllegvels of society, in all places and at all times. “ Dr. Garland, Editor of NEJM, 195f’in2 This is hardly more true than with child mortality When we talk about cholera, ebola, HIV/AIDS, TB – all of these diseases are so intertwined with the socio-economic conditions under which they exist: Overcrowding, lack of clean water, poor nutrition, poor sanitation, walking long distances to access health care – stock outs, no staff, etc…..

HIV/AIDS/TB

Food Insecurity Programs Giving medicines without food is like washing your hands and drying them in the dirt. – Haitian words of wisdom Photos Top right: Malnourished child in Lesotho, before and after treatment Bottom right: PTMTC program in Rwanda (distribution of infant formula to prevent HIV transmission) Bottom: School children receiving free lunches in Haiti. Often, these are the only meal these children will have for the entire day. Food Food is a potent vaccine to prevent the main cause of child mortality–the combination of hunger, malnutrition and common infectious diseases that kills more than 5 million children every year. And food is essential medicine for the sick, especially for people suffering from consumptive diseases like HIV and TB. Symptomatic HIV patients require 20 to 30 percent more calories than HIV-negative people of the same age, sex, and physical activity level.

A warm, dry place to sleep You can imagine how hard it would be to be in good health, if every time it rained the water poured through your roof and made a mud pit out of your dirt floor. We work with our partners and employ people in the community to build homes with concrete floors and tin roofs. A warm, dry place to sleep

Lack of access to clean water is a major threat to public health. Millions of people to walk two miles or five miles or more to collect water to drink, cook or wash. Sometimes it’s clean, but many times it isn’t. Waterborne diseases – like cholera – end millions of lives every year. We work with partners like Charity Water and others to provide community and household based water interventions, and advocate for long-term solutions by bolstering the public sector, so it can deliver clean water (and adequate sanitation) as a public good. Clean water to drink

One clear way to address hunger and malnutrition is to give people something to eat. We provide direct food support, with nourimamba (an vitamin enriched peanut butter to treat childhood malnutrition) and free lunches in schools. We also support agricultural initiatives (Zanmi Agrikol) to help communities grow more of their own food to eat and bring to market. Enough food to eat

Cholera

Cholera--October 20, 2013 “I worked all night at the hospital with a few colleagues; we were two doctors and six nurses for more than 300 patients who needed IV fluids. We were overwhelmed by the immensity of this tragedy. Many of those 300 patients died that day. They came too late to the hospital and from too far away to be taken care of by too few providers” Dr. Almazor, Zanmi Lasante

Cholera Killed 5,000 Haitians in its first year. Three years after the outbreak, about 8,400 Haitians have died from cholera and more than 685,000 have become sick—approximately one in 15 people. Outbreak was quickly classified as the worst cholera epidemic in the world.

Comprehensive Approach Education/ Outreach ZL Community Health Nurses Advocacy Safe Water Sanitation system UN accountability Treatment Oral rehydration Intravenous fluids Vaccination A total of 45,417 people in two communities received at least one dose of the two-dose vaccine, representing 77 to 93 percent of the targeted population. 91 percentage of people who received the first dose also received the second, an excellent completion rate.

Health Systems Strengthening Community-based Hospital-linked Health center-enriched

We Strengthen Health Systems Build local capacity by hiring and training local people to work with us as community health workers, doctors, nurses, pharmacists and technicians. Work with the public sector to support existing health centers by providing equipment, medicines, staffing and training, and build new facilities. We forge long-term partnerships with the communities we serve to build and strengthen health systems. We work with the national ministry of health and/or district-level public health officials to support existing health centers, by providing equipment and medicines, and hiring and training staff at the community and health center level – e.g. Haiti, Rwanda, Lesotho, Malawi, etc. We also with partner with the government to build new facilities – e.g. Butaro in Rwanda, Mirebalais in Haiti

Cancer Care at University Hospital

“ Massive poverty and obscene inequality are such terrible scourges of our times… that they have to rank alongside slavery and apartheid as social ills… like slavery and apartheid, poverty is not natural. It is man-made, and it can be overcome and eradicated by the actions of human beings. “ Nelson Mandela, 2005 Nelson Mandela

Thank-you Cory McMahon- cmcmahon@pih.org