Partners in Health


A Q&A with the other banker to the poor, World Bank Prez Jim Kim | 

The activist-physician president of the World Bank, Jim Yong Kim, was in Seattle today to talk with folks at the Bill & Melinda Gates Foundation about their mutual interests in fighting poverty, reducing inequity and generally trying to make the world a better place. I wasn’t able to attend, but I did chat with Kim by telephone prior to the meeting.

Dr. Jim Kim
Dr. Jim Kim

Kim, before becoming an anti-poverty banker, was best known as the other half of the leadership at the health advocacy organization run by Paul Farmer, Partners in Health. Kim and Farmer showed, among many things, that complex TB and HIV treatments could be successfully done in poor communities. Both have been outspoken about the need to view health and poverty within a human rights context. Kim’s appointment by President Barack Obama to take the helm of the World Bank was highly controversial, to some extent because he was a physician rather than a policymaker, finance guy or economist. We asked him if things have calmed down, and when we can declare an end to poverty.

Irony note: Twenty years ago, Kim was outside on the street protesting against the World Bank. Now, he’s running it.

Q So how does it feel to be a banker trying to cure economic ills rather than a doctor fighting epidemics?

JK:  The World Bank is really an extraordinary organization. The thing that surprised me is that this place is just full of extremely talented people who are passionate about fighting poverty. These are people who could have worked in other places, in finance, and made a lot more money but they are here to fight poverty. This is a bank with the mission of fighting poverty…. One of the things I’ve learned in taking this job is how critical it is to understand these complicated development problems within the context of economics and finance.

Q Are you guys holding any mortgage-backed derivatives? :-)

JK: We are very highly regulated and closely watched. (So I guess that means no….)

Q When you were nominated, some said your concept of development – as a physician, focused on people – was not a good fit with the World Bank because it is an organization focused on “national development.” One expert and critic called your appointment an “intrusion of humane development into national development.” Response? Continue reading

North Korea facing hidden Tuberculosis crisis | 

Dr. KJ Seung in North Korea.
Dr. KJ Seung in North Korea.
The Eugene Bell Foundation

Multidrug-resistant tuberculosis (MDR-TB) is a global problem, but one that is particularly worrisome in Asia. An estimated 60% of the 500,00 MDR-TB cases in 2011 occurred in Brazil, China, India, Russia and South Africa. The problem is made worse by the low number of people with MDR-TB enrolled in treatment in countries like China, Myanmar and India.

Information on MDR-TB in the reclusive North Korea has been hard to come by, until now. Dr. KJ Seung has been working in North Korea on TB for years and heard from his colleagues that first-line TB drugs were not working for patients.

“I’ve treated MDR-TB in a lot of different countries, but the situation in North Korea is the worst I’ve ever seen,” he said in a recent interview with PIH. “There are simply too many patients. At every sanatorium we visit, there are lines of patients who have failed multiple courses of treatment with regular TB drugs and are hoping to get into our treatment program.”

Dr Seung decided to analyzed sputum samples from 245 of TB patients to get to the bottom of it. His results were stunning. Eighty-seven percent of the patients analyzed have MDR-TB. The results of the study were published this week in the open-access medical journal PLOS Medicine. Continue reading

Rwanda’s revolutionary prescription for health | 

Editor’s note: This is a follow up (a day or so behind schedule) to an article I did last week on what many see as the humanitarian dilemma of Rwanda – a success story in aid and development in an nation with a questionable record on basic freedoms and human rights. Since it’s original posting, I’ve made changes to clarify that everyone agrees community health workers are invaluable to success. The question is one of emphasis.


Rwanda is widely celebrated for having demonstrated that major improvements in health can be achieved in a poor country, at relatively low cost per capita, by good strategy, innovation and focusing on the best bang for the buck.

Peter Drobac
Peter Drobac

“There’s really been an extraordinary level of leadership by the Rwandan government, in terms of central planning and coordination,” said Peter Drobac, Rwanda director of Partners in Health, the health aid and advocacy organization founded by physician-activist Paul Farmer and Jim Y. Kim, now director of the World Bank.

The Rwandan government has implemented an insurance program that has covered most of the population with an emphasis on basic, preventative care that the British Medical Journal recently reported has greatly increased life expectancy, significantly reduced AIDS and TB as well as maternal and child mortality — all for about $55 per person.

“I think we’ve learned some lessons here that can be applied universally,” said Drobac.

Rwanda is being held up as a model within the global health community, but planning and coordination is nothing without execution. Digging down past all the sound-bites and buzz words, what has really made the difference?

Arguably, some of the more critical players in this scheme have been relegated to a minor supporting role when it’s possible they are actually in the lead.

Community health workers. Rwanda has 45,000 of them, or about three per village.

Partners in  Health has been a pioneer, and major proponent of the use of community health workers to extend the reach of the health system in poor countries. But Sachs thinks their role still remains underappreciated in media reports and policy discussions.

Jeff Sachs
Jeff Sachs
Columbia University

“There has been a dramatic change in terms of what you can do with community health workers in poor villages,” said Jeffrey Sachs, a leading aid and development economist who has recently proposed a massive expansion of community health workers as the most powerful means to achieve many key global health goals. Advances in diagnosis and treatment along with the ubiquitous cell phone means lower-skilled health workers have a greatly expanded care repertoire.

Rather than continue to focus on disease-specific interventions or trying to increase high-level health capacity, Sachs thinks the most obvious lesson learned from Rwanda’s success in health is that these low-level trained health workers are most powerful.

“This is a new idea,” Sachs said. “We’ve had community health workers for many years, but they are generally viewed as complementary components when what I’m talking about is making them central components in a new system of public health.” Continue reading

Rwanda: The humanitarian’s dilemma | 

Physicians with the health advocacy group Partners in Health visit with child patients at the hospital they helped build in Butaro, Rwanda
Physicians with the health advocacy group Partners in Health visit with child patients at the hospital they helped build in Butaro, Rwanda
Tom Paulson

Rwanda is a beautiful example of how even the most devastated country can, with enough support and the right kind of planning, make a stunning recovery and get itself on the path of progress.

On many indicators of health and welfare, as well as economic growth, Rwanda is at the top of the list in Africa and, in some cases, globally. I’ve seen the evidence for this in person, having visited and reported on Rwanda more than a year ago. It is an impressive ‘success story’ – a story that gets repeated over and over and over.

But a bizarre juxtaposition of events that took place this week illustrates, for some anyway, the dilemma that Rwanda poses for the humanitarian community.

Bosco Ntaganda
Bosco Ntaganda

An alleged war criminal, Bosco Ntaganda, who many believe was fomenting violence in eastern Congo at the direction of the Rwandan government this week sought refuge in the U.S. embassy in Rwanda’s capital, Kigali. Rwandan officials, who deny any connection to Ntaganda, nevertheless had to promise the U.S. ambassador they’d allow the warlord to be extradited.

Days before that, late last week, Rwanda’s Minister of Health Agnes Binagwaho was celebrated at a big global health meeting in Washington, DC, for her country’s rapid progress against poverty and injustice. Twitter went nuts with people referring to Binagwaho as “inspiring, amazing” – a veritable “rock star” for the aid and development community.

You can argue, as some did with me, that trying to link these two events together is unjustified and misleading.

Yet you could also argue they are fairly difficult to de-link — in that foreign aid is a big reason for Rwanda’s celebrated success in health and threatening to withhold foreign aid is how the US government, the Brits and others have been trying to encourage Rwanda to stop messing around in Congo. Continue reading

Surprise! Putting a doctor activist in charge of World Bank controversial | 

Dr. Jim Kim

When President Barack Obama last week announced that he was nominating Dr. Jim Kim, an outspoken poverty advocate and physician, to take the helm of the World Bank, it was a surprise to almost everyone.

Kim is currently president at Dartmouth College but is best known as the physician co-founder, with Paul Farmer, of the renowned anti-poverty and health improvement organization Partners in Health. He was a surprise nomination because he isn’t a banker, a financial expert or a politician at sunset looking for new pastures to practice the art of compromise.

And like Paul Farmer, he is passionate, fearless and fairly uncompromising in the fight to defeat global poverty, and the diseases of poverty. This is why so many in the global health and development community are excited about his nomination to head up the World Bank — and also why Kim may become the first U.S. nominee to face a serious challenge for the post.

I happen to know of at least one job search Kim reportedly got dropped from due to his tendency to say what he thinks. Continue reading

Digging deeper into the cycle of poverty and disease | 

It seems pretty obvious to most of us regular folks that being poor also increases your risk of being in poor health and that, conversely, illness can make you poor.

And it seems pretty clear that this is even more so for the very poor living in parts of Africa or elsewhere in the developing world where there are few social safety nets, no disability insurance programs, many more deadly and disabling health threats — and your ability to work is basically a matter of survival.

Apparently, it’s not so clear or obvious to many experts and academics.

Tom Paulson

Matthew Bonds

That’s why Matthew Bonds, who lives and works in Rwanda with the organization created by health activist Paul Farmer called Partners in Health, is trying to bring clarity and hard numbers to what many know as the “cycle of poverty and disease.”

“Yeah, my wife keeps asking me why we need to do this, too,” laughed Bonds, who spoke yesterday at the UW’s Institute for Health Metrics and Evaluation. Continue reading

Global Health is More than Health | 

Here’s a good description, in an interview with one of the program leaders of Partners in Health’s Haiti program, about why improving “global health” must include social, economic and human rights issues:

Good Health Means Justice and Rights: Huff Po interview with Loune Viaud.