Partners in Health, the Boston-based global health nonprofit founded in part by Dr. Paul Farmer, Ophelia Dahl and Jim Kim, has had a long history of combating healthcare inequality in nearly a dozen countries around the globe.

But in 2020 the organization was tasked with aiding an ineffective healthcare system closer to home: the United States.

At the onset of the Covid-19 pandemic, Governor Baker’s administration recruited Partners in Health to develop a contact tracing system in Massachusetts.

“What we ended up doing was making sure that we connected people to services right away,” Dr. John C. Welch said earlier this week at a gathering at the First Congregational Church of West Tisbury. “We’d make them feel taken care of. We wrote to employers to make sure they could stay home and get better without being fired, we did a lot of eviction diversion work to keep people in their homes. We wanted to keep people safe and feeling human, feeling important.”

Dr. Welch is the director of flagship and special projects at PIH. In a conversation with Dr. Joia Mukherjee, PIH’s chief medical officer, the pair discussed the organization’s mission, its response to the Covid epidemic and the lingering effects of the sudden death in February of the charismatic and steadfast leader of the organization, Dr. Paul Farmer.

Rev. Cathlin Baker, one of the event’s hosts, introduced Dr. Welch and Dr. Mukherjee both as living examples of “liberation theology,” or the practice of carrying out God’s word through uplifting the oppressed.

Whether dealing with medical issues in post-earthquake Haiti, the Ebola outbreak in Sierra Leone or the Covid pandemic, organization leaders said their mission has always remained the same: put the patients first.

“It was essential that our Covid contact tracing system not just be making phone calls and collecting data,” Dr. Welch said. “It had to be about taking care of patients, and the challenge was that we couldn’t physically connect with them.”

Dr. Welch and Dr. Mukherjee also talked to the group assembled about the organization’s wider mission and the challenges they have faced over the years. A big part of PIH’s mission is to create health care solutions by empowering and enabling local populations to staff their own hospitals and healthcare services. Out of a staff of 19,000 globally, Dr. Mukherjee said only 100 of them are Americans.

Dr. Mukherjee, a public health and infectious disease specialist and associate professor at Harvard University, began her work with PIH in the early ‘90s, doing HIV prevention education for children in rural Uganda. Dr. Mukherjee said that when she asked what the number-one risk factor for HIV in their communities was, every child answered, “poverty.” She was at first taken aback, but quickly learned that the economic realities of these children, many of them orphaned by HIV, gave them few options.

“Prevention requires means, what we call agency in the science community,” Dr. Mukherjee said. “The number-one risk population for HIV was underage girls who were heads of their households.”

For many patients in under-resourced countries, there is also a prevailing attitude that their health is simply not worth the investment, both Dr. Mukherjee and Dr. Welch observed. Early in his career, while working in PIH’s hospital in Mirebalais, Haiti, Dr. Welch encountered a patient who had suffered a clavicle injury, a very difficult, technical procedure for even an experienced surgeon operating in a fully equipped hospital.

“Some people would have just taken his arm off and saved themselves the trouble,” Dr. Welch said. “But when you get to know the patients, you understand what they do for work, how their livelihood would be upended. We managed to fix it after 10 hours of surgery and that man is still alive today.”

The PIH leaders said the organization is guided by a holistic approach, what they refer to as the “5 S’s,” meaning staff, stuff, space, systems of care, and social support. When PIH works with a country, the goal is not just crisis response, but strengthening primary healthcare overall.

“As we learned with Covid, you can’t just focus on one problem, one disease, or you lose basic care,” Dr. Welch told the crowd. “The whole system gets inundated.”

In a slide above his head, an image of a bare-bones operating room was projected onto the wall. Many of the facilities Dr. Welch works in have no running water, so operating tools are instead sterilized in boiling pots of water. These conditions are not unusual in the countries PIH operates, but both Dr. Mukherjee and Dr. Welch stressed that could be overcome with adequate investment in public health infrastructure.

“Our emphasis on partnering with federal governments doesn’t necessarily make us popular with the [United States] government,” Dr. Mukherjee remarked, adding that PIH largely relies on individual donors to keep their programs running.

In light of rising Covid cases of BA.5 and the emerging monkeypox epidemic in the U.S., Dr. Mukherjee and Dr. Welch expressed frustration with the current public health response. Unlike every other country PIH works in, the United States does not suffer from a lack of resources, they said.

“This is a result of decades of defunding our public health infrastructure,” Dr. Welch said. “We know what [the solutions] are, they just need to be funded.”