Partners in Health battles diseases with missionary zeal

By Eileen K. McCluskey

Special to the Gazette

Carmen once worked as a nurse's aide in a public health clinic in Lima, Peru. In 1996 she contracted a virulent, difficult-to-treat, and easily spread form of TB called multidrug-resistant tuberculosis (MDRTB).

Because she did not respond to standard "first-line" antibiotics, Carmen was told by Lima's public health practitioners that nothing further could be done for her. But MDRTB is treatable -- and in Carmen's case, the disease succumbed to a combination of antibiotics provided by the nonprofit organization, Partners In Health (PIH).

Paul Farmer, MD-PhD '90, associate professor at the Medical School and a founder of PIH, reported this year in a speech to the Catholic Health Association of America and the National Association of Catholic Chaplains that Carmen's treatment had been abandoned by the Peruvian health care system "in keeping with World Health Organization [WHO] recommendations," which has determined "that the treatment of MDRTB is not 'cost-effective' in poor countries."

Jim Yong Kim, MD-PhD '91, executive director of PIH and an instructor at the Medical School, reports that TB currently causes "3 million deaths a year, mostly in poor countries."

The WHO recently reported that among those who are sick with TB, the proportion of cases that are multidrug-resistant is much higher than previously estimated. Kim argues that unless measures are taken immediately to stem the spread of MDRTB in places like Lima, where it finds strongholds in areas afflicted by poverty, the worldwide spread of MDRTB will be inevitable.

"It's been called ebola with wings," Kim says, referring to the untreatable virus that, in Zaire and Sudan, killed a high percentage of the people who were infected. "While most strains of MDRTB are still treatable," he continues, "in the absence of a timely and well-coordinated global treatment strategy, many TB specialists fear that the world will once again face the specter of incurable tuberculosis."

The spread of MDRTB within families, in airplanes, and in health care institutions has been amply demonstrated, according to PIH. While treatment is unpleasant, the regimens, which involve a combination of antibiotics, have, as in Carmen's case, proved effective.

"To date, more than 50 patients with MDRTB in Carabayllo, Peru, have been receiving individually tailored treatment regimens. Our cure rate is close to 90 percent and, as far as we know, we are the first group in the world that has had these kinds of results treating MDRTB in poor communities," says Kim.

The cost of curing patients in Peru is much smaller than in the United States, where state-of-the-art isolation facilities are the norm for those afflicted with MDRTB. In the U.S., the cost per person can run as high as $250,000 annually. In Peru the cost of treatment varies with each patient but in all cases is less than $10,000. PIH is currently working with representatives of the pharmaceutical industry to further lower the cost of treatment.

Even so, Kim says he and his PIH colleagues are finding that "the Lima outbreak is larger than we originally imagined, and we are running out of funds to buy the medications required to complete therapy for these patients.

"Individual donations are the most important part of our funding base," he adds, noting that both he and Farmer donate portions of their own salaries to Partners In Health. "Paul gives through the Community Gifts program," says Kim. "I give directly, since I don't receive a Harvard-based salary.

"Our first priority has always been to work against injustice by providing basic services to poor people -- working to change international health policy is a new experience for us," notes Kim. "In drawing attention to the impending disaster of untreated MDRTB, and to the insidious 'logic' of cost-effectiveness, we feel we are remaining true to our original mission."