Partners in Health

I was looking at the monthly e-newletter from PIH, which is the organization founded by Paul Farmer, MD. The book MOUNTAINS BEYOND MOUNTAINS details the life and work of this extreaordinary physician, who is treating the poorest of the poor in Haiti, and in many other places now as well. He has tremendously changed the way international health programs deal with Tuberculosis and HIV/AIDS. The article which caught my attention is by a midwife who is volunteering in Haiti, and was answering a question-- "what is women's health?" She answers that when women are coming in for screening for cervical cancer (Pap smears), they ask questions about their children, and their children's health, and also about sexuality, relationships with spouse or significant other, contraception and family planning, domestic violence, how to increase the family income so their children can have a better future, nutrition and self-care, among other things.
These are the same sorts of concerns women have here, and yet we are supposed to code the visits only around issues of a "gynecologic finding or disease". I am sick of this myopic set of rules, with built-in non-rewards for trying to meet the needs of patients one-on-one, in the issues of their lives. I am sick of the insurance companies knowing what I talk with my patients about, because I don't think it is their business, and it removes privacy from the patients. The whole stupid morass we got into with HIPPA was to help with privacy, but it is a freeway of information to the insurance company while there is a stranglehold on being able to give family members relevant information to help them deal with the illnesses of their loved ones.
Anyway, I really love the work that PIH is doing in Haiti and in other places, and one of the most valuable things is to give each patient an accompanying person, as an advocate who helps keep them coming for their appointments, and who makes sure they are eating and sleeping, and taking their medicines. Small stipends are given to the starving patients with Tuberculosis, to make sure they get enough to eat. Traditionally, Tuberculosis is a disease of poverty, and when people can't eat well, they are so tired and listless that they end up dying of this disease. They NEED to eat, to be able to keep their immune function strong. Same with HIV/AIDS. SO the idea of the "accompagnateur" is vital.
What is also a big piece of the puzzle for countries with very high amounts of poverty-stricken people is that there are not enough resources for public health. This includes the money for securing a safe water supply-- putting in wells and pipes and plumbing for towns; and keeping the latrines away from the water sources. In Paraguay, most of the children were severely anemic, because they walked barefoot, and hookworms would enter their feet from the grass. The hookworms have a fecal pathway, and if the rains washed contaminated waste matter into the grasses and fields, the next cycle would begin again. We were able to reduce the childhood anemia and infestation rates tremendously once we started helping each family to get a concrete floor for the latrines, and to help them choose a site for it where the water supply would not be endangered in the flooding rains.
I hope you will take a look at the PIH website, and maybe become a donor. The work they are doing is so important!