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Two of PIVOT’s co-founders, Jim and Robin Herrnstein, are formally trained as scientists (in astrophysics). As a consequence of personal experiences in Africa years ago, they had been searching for meaningful ways to address the needs they had witnessed among the poor. They were introduced to Madagascar through the work of Professor Pat Wright, who was raising funds for a new research facility for Stony Brook University’s Centre ValBio (CVB), adjacent to Ranomafana National Park (RNP). Ranomafana is a special place. A World Heritage site of mountainous tropical rainforest, RNP is home to 13 species of lemurs and a vast diversity of other flora and fauna. It was established as a national park in 1991 largely due to Pat’s initiative. When Jim and Robin visited RNP, they were awed by the wondrous biodiversity, but also struck by the affliction of poverty in the area.

Pat’s successes in both conservation and research stem from longstanding relationships with the people of Madagascar manifest in range of outreach programs including health and hygiene. Inspired by this opportunity, Jim and Robin proposed that the plans for the new research facility include an infectious disease lab. Their premise was that this would attract world class infectious disease scientists, produce valuable knowledge with benefits to the local population, and also serve as an entry point for a broader and more aggressive agenda for health service.

The question of exactly how such scientific research could directly serve the interests of the local population led Jim and Robin to Matt Bonds who, as an economist and disease ecologist working with Partners in Health in Rwanda, had been grappling with similar questions for many years. Matt recruited Dr. Michael Rich, who was the founding director of PIH Rwanda and is an expert on building health care delivery systems. In addition to the health care and research opportunities, Matt and Michael shared a sense of inspiration by the prospect that this could further bolster the conservation agenda. After a series of formal assessments of the health conditions in Madagascar, the challenges for health care delivery, engagement with the Madagascar government and local leaders around Ranomafana, the team consolidated around a unique vision for a health care project. As a scientific ally in this process, Jim and Robin seeded a new Global Health Institute at Stony Brook University.

PIVOT’s primary goal is to deliver health care for the rural poor in Madagascar, serving as a model for other parts of the country. This rights-based focus on the needs of patients compels the organization to stand independently from its university-affiliated partners at CVB, SBU, and Harvard. These research partners, however, are central to PIVOT’s mission of supporting health care delivery through rigorous scientific research on both operations and underlying causes of poverty and disease. PIVOT’s goal is thus not only to spread the global health movement, but also to integrate this with a broader agenda for sustainable development, and help catalyze a new movement of scientific research inspired by the needs of the poor.

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