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Rising to meet an infinite need

Partners in Health, long a force in Haiti, vaults into central role

By Stephen Smith and James F. Smith
Globe Staff / January 24, 2010

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CANGE, Haiti - His hometown in ruins, his right arm broken, Frantz Verdieu knew he had to escape the acrid air and rubble-strewn streets of Port-au-Prince.

There was, he decided in the desperate hours after the earthquake that sundered the capital city, only one place to seek safe harbor and medical care: Cange, a town of about 30,000 in Haiti’s Central Plateau, and the birthplace of Partners in Health.

So he traversed mountain roads - rough as a washboard in patches - along with hundreds of others who fled here by auto, truck, and bus. Overnight, they crowded Cange with their needs, and transformed the mission of an organization that for 25 years has built a worldwide reputation by treating tuberculosis, AIDS, and other chronic diseases that flourish among Haiti’s poor.

“I took four cars to get here,’’ the 34-year-old teacher said, sitting inside a chapel converted into a ward for the injured on the organization’s bucolic but overrun campus. “I heard about the name before, and I knew I needed to get here.’’

With 10 hospitals and deep roots in Haiti, Boston-based Partners in Health has became one of the pillars of the worldwide response to the Jan. 12 earthquake.

This sudden prominence has forced the nonprofit to grow at warp speed, as it raised an astounding $25 million in just the first week. Its e-mail list leaped from 28,000 to 160,000 addresses, and so many calls are pouring into its Commonwealth Avenue offices that five people have been assigned to answer the phones.

As enviable as this sudden expansion might seem, Partners in Health never aspired to become the go-to organization after the quake. As its Boston staffers constantly reminded a visiting reporter last week, Partners in Health is not a disaster relief organization.

Still, the money and visibility have positioned Partners in Health to be a leading player in the country’s recovery, helping Haitians rebuild their shattered health system. And that role would be closer to the organization’s founding purpose - to work over the long haul with health officials in developing countries to help them create systems to treat the poor.

“We know from experience that the short-term crisis very quickly turns to one of how you address the infections that people will get later,’’ said Ophelia Dahl, the executive director. “Once they’ve been kept alive, these people are going to need a house, and access to medical care.’’

Two hours from Cange, Dr. Evan Lyon on Friday morning bounded across the frenzied campus of Port-au-Prince’s main hospital, its dusty streets clogged with billowing tents sheltering hundreds of moaning patients. At the behest of Haiti’s health ministry, Lyon, an Alabama doctor who has long worked with Partners in Health in Haiti, was organizing the aid groups that flooded Haiti’s University and Educational Hospital.

It is a foreshadowing of the role Partners in Health is poised to assume in the rebuilding of Haiti.

Last week, after conversations between the nonprofit’s founder, Dr. Paul Farmer, and the government of Haitian President Rene Preval, the organization was asked to apply its model of patient care to those displaced by the earthquake and its aftermath.

The need will intensify in the coming months and years. “They need someone to be with them and to do simple care-giving, whether that’s changing their dressing, changing their bedpan, holding their hand, walking to get the food they can’t get because they don’t have a leg,’’ said Lyon, who worked the crowd on the hospital grounds, pumping doctors’ hands, greeting soldiers, ducking in to check on surgeries. “That system of community care is what Partners in Health can contribute.’’

Orchestrating relief efforts
At noontime Thursday in Boston, more than 40 staff members crowded into the main conference room in the headquarters of Partners in Health for the daily “People, Planes and Stuff Meeting,’’ to track the swirl of flights, surgeons, and supplies pouring into Haiti.

Team leaders gave terse reports: Four flights chartered by the group are en route to Haiti, including “the LA-Matt Damon plane.’’ Satellite phones and walkie-talkies are in short supply. The Chilean airline will loan a warehouse at the Miami airport that can hold 800 tons of medical supplies. And the procurement staff has found six trucks for sale in the Dominican Republic and snapped them all up.

It was just one of dozens of meetings in a blur of 24-hour days for the 70 full-time staffers and dozens more volunteers who are orchestrating the massive relief effort, fortified by donated pizza and coffee. They work in a warren of cubicles in the organization’s new 12,000-square-foot headquarters near Boston University, and have borrowed vacant space across the hall to accommodate volunteers.

That’s a long way from the one-room office over a restaurant in Cambridge where Farmer and Dahl and a few colleagues launched Partners in Health in 1987 to support their growing work in Haiti. Farmer had first worked in the central highlands as a Harvard Medical School student in 1983, and he met Dahl, then an 18-year-old volunteer at an eye clinic in Haiti.

Partners in Health now has a $63 million budget and 11,000 employees in 12 countries. More than 4,000 are Haitians, from doctors and nurses to networks of community health workers working in the central highlands. Hundreds of them raced to Port-au-Prince as soon as the quake hit, said chief operating officer Paul Zintl.

“This is a practical, fast moving, nimble organization. People keep saying, ‘Do what it takes, and figure it out.’ ’’

The combination of capacity and credibility in Haiti put Partners in Health in a unique position to lead disaster relief operations. Money and offers of help poured in, without any prodding.

So many doctors and nurses offered to go to Haiti in the first few days, Zintl said, that Partners in Health was able to adjust the mix of volunteers to meet changing needs. When the medical teams became “doctor-heavy,’’ more nurses were sent, and then more anesthetists. Well over 100 foreign volunteers are now staffing surgical teams dispatched to Port-au-Prince by Partners in Health.

Technology has played a key role. Partners in Health’s communications team had spent months preparing a website upgrade with volunteer help from Blue State Digital, which designed then-candidate Barack Obama’s fund-raising website. When the quake struck, Web coordinator David West hurriedly launched the new front page, with a blog, Twitter and Facebook links.

In the first week, not only did individual donations pour in but 1,300 people used it to set up their own fund-raising pages. If they meet their goals, they will raise $7 million for Partners in Health’s Haiti relief and rebuilding.

Celebrities are helping, too. Matt Damon arranged to fly surgeons from Los Angeles on Mel Gibson’s jet. Meryl Streep appealed for support at the Golden Globe awards. James Taylor gave two benefit concerts on Friday and Saturday nights for the organization, and matched the proceeds himself, raising about $600,000.

No doubt much of the outpouring flows from the prominence of Farmer himself. He was appointed deputy United Nations envoy to Haiti by the envoy, former President Bill Clinton.

A best-selling 2003 book by Tracy Kidder, “Mountains Beyond Mountains,’’ raised Farmer’s profile nationally, describing his relentless work ethic and his crusading campaigns not only to improve health systems but to get at the underlying social and economic imbalances in Haiti, Peru, Rwanda, and elsewhere.

But Farmer now wears many hats - at the UN, at Harvard Medical School, and at Brigham and Women’s Hospital - and others are in charge of day-to-day operations at Partners in Health.

Dahl’s reassuring, patient style and the confidence she commands after 27 years of work with Haiti help reduce tensions among the staffers, even as they work under relentless pressure.

“We feel that there’s an emergency all the time,’’ Dahl said in an interview. “So there’s a certain high level of pressure on us all the time.’’

Return to Cange
A starry night Friday settled around the gently sloping terrain where Partners in Health is nestled in Cange. Inside the chapel, with its small altar and mural of Christ on the cross, Dr. Fredly Petiote was deep into his 13th hour of work.

Petiote and other physicians were checking on the 50 or so patients lying on mattresses on the white tile floor. Legs and arms were in casts, heads in bandages, necks in foam braces. There were about 140 patients in all, some in a makeshift ward carved from a storage area.

One patient had a dangerously swollen right leg. The man had been trapped for hours, his leg sandwiched between iron bars. Now, his kidneys were collapsing because of toxins released by his injured leg muscles.

After the earthquake struck, Naomie Marcelin, like many other staff members who hail from Port-au-Prince, hurried home. She discovered heartbreak: Her sister and niece lay dead in the ruins of a church.

Even as she grieved, it became clear what she must do: She must return to Cange. For two days, she was the only registered nurse here.

“Yes, I lost my sister and niece,’’ Marcelin said, her voice barely a whisper, her face serene. “I told myself I can’t have them back. So if I can help sick people get better, that is exactly what my sister would want me to do.

“I’m helping other people stay alive. That is my strength.’’

Stephen Smith reported from Haiti, and James F. Smith from Boston.