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BWH physician serves as anesthesiology faculty in Rwanda

Building capacity in specialty care is key to BWH partnership with Human Resources for Health Rwanda
From BWH Bulletin 8/25/16 by Jessica Zimmerman

Training residents in anesthesiology is not only about teaching them the medicine behind the specialty, says Jill Lanahan, MD, of the BWH Department of Anesthesiology, Perioperative and Pain Medicine. It’s also about sharing a passion for the profession to inspire them to join the field.

Lanahan has done exactly that at the Brigham since March 2014, and for the next year she will share that same expertise and enthusiasm for anesthesiology with the next g16_08_25_jill_Lanahaneneration of physicians in Rwanda as part of the Human Resources for Health (HRH) Program, a collaborative, seven-year project between the Rwandan government, BWH, Harvard Medical School and more than 20 other academic institutions in the U.S. The program recently began its fifth year.

Lanahan—who relocated with her family to the Rwandan capital, Kigali, on Aug. 2—will spend one day each week doing didactic training with her new crop of residents. The other four days will consist of clinical training in the operating room. During her year-long position, she will offer three months of training in cardiac anesthesia, her primary area of clinical interest.

Although she has long had a desire to get involved in global health, Lanahan says HRH piqued her interest after chatting with two BWH colleagues in her department who were alumni of the program: Stewart Chritton, MD, PhD, and Ramon Martin, MD, PhD. She felt compelled to participate after learning just how scarce anesthesiologists are in Rwanda.

“There are fewer than 20 anesthesiologists in the whole country, and we have more than 100 in our department at the Brigham,” she said. “There’s a critical need for anesthesiologists in Rwanda.”

In Rwanda, there may only be one anesthesiologist per hospital, Lanahan explained. In addition, anesthesia is often administered by technicians—whose highest level of education is typically a high school diploma—rather than physicians or nurses, she said. In comparison, only licensed anesthesiologists and nurse anesthetists may provide anesthesia to a patient in Massachusetts.

The lack of specialized training can be deadly, Lanahan said.

“People fear anesthesia in Rwanda, and part of it is because there’s a higher morbidity and mortality rate associated with it,” she said. “By training specialists in anesthesia, we can increase the likelihood that it will be administered safely to patients.”

As part of its broader goal to build a more self-sustaining health care system in Rwanda, the program has gradually sent fewer U.S. clinicians each year to train residents.

Lanahan is one of a handful of anesthesiologists in attendance this year.

“The idea is that if a resident from a country such as Rwanda goes elsewhere to train, they might not come back to their home country,” Lanahan said. “So by bringing doctors to Rwanda, you can train them in their own environment and expand the number of physicians there.”

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Combating Human Trafficking: An Interview With Hanni Marie Stoklosa, MD, MPH

Interview with Hanni Marie Stoklosa, MD, MPH

By Rachel I. Fortinsky

Dr. Hanni M. Stoklosa, MD, MPH

Hanni Marie Stoklosa, MD, MPH’s background as a BWH emergency physician has inspired her work in addressing human trafficking. She founded an organization focused on combating human trafficking. Health Education Advocacy Linkage (HEAL) Trafficking  (www.healtrafficking.org)  focuses on addressing the health-related problems that trafficked victims face from a public health standpoint. In her role as researcher, advocate, and nationally and internationally recognized expert, she has years of experience in addressing this global problem. Dr. Stoklosa has done extensive research in all areas of trafficking including sex trafficking and labor trafficking. She is a leading force in addressing the myriad of health issues which are often overlooked by health professionals, as well as a force in advocating for human trafficking legislation before the US Congress. Dr. Stoklosa has advised the US Department of Health and Human Services and was recently named an American Board of Emergency Medicine fellow (2015-2017) of the National Academy of Medicine (formerly the Institute of Medicine). She holds appointments at Harvard Medical School, the Harvard T. H. Chan School of Public Health and the Harvard Humanitarian Initiative. She has extensive international experience in many countries.  “I conducted qualitative interviews to further understand the anti-trafficking landscape and the gaps in response.” Her work has affected populations in India, Nepal, Thailand, and Kazakhstan, as well as Australia, China, Egypt, Guatemala, Liberia, the Philippines, South Sudan, and Taiwan. Most recently, Dr. Stoklosa has written a text (forthcoming, Springer Publishing in 2017) Human Trafficking Is a Public Health Issue: A Paradigm Expansion in the United States.

The US Department of State views human trafficking as a form of modern day slavery. Each year, a Trafficking in Persons (TIP) Report is generated by the Department of State. As Secretary of State John F. Kerry stated: “The TIP Report is the product of a yearlong effort requiring contributions and follow-up from employees in the United States and at our diplomatic outposts across the globe, host country governments, and civil society” (US Department of State TIP website, 2016). Overall, Dr. Stoklosa noted that she is impressed with the efforts of the Obama Administration in addressing human trafficking. She offered examples of successes and shared her optimism with the five-year federal strategic action plan. Dr. Stoklosa stated, The federal government laid out a multi-sectoral response which encourages intra-federal agency collaboration. The plan helps break down silos and create cross links to enhance responses trafficking.” President Obama also formed an advisory committee consisting of human trafficking survivors to guide federal approaches from the victims’ perspective.

In her role as a BWH Emergency Department physician, Dr. Stoklosa says the department treats approximately one to two trafficked patients weekly. Although trafficking is often viewed as an international problem in resource-limited settings, the US and the Boston area are not immune to the problem. When identified in the BWH Emergency Department often the patients can be followed in the CARE clinic which is overseen by Annie Lewis-O’Connor, PhD, RN, NP, FAAN. Identification and assessment of trafficked patients is challenging. Often patients do not think of themselves as trafficked or are reluctant to disclose information out of fear, shame or denial. Similar to those who are affected by intimate partner violence, “the focus is not on rescue, but meeting patients where they are at, and caring for their stated needs.”  She has written a paper on HIPPA and Human Trafficking which addresses the complex privacy issues in caring for trafficked individuals. An emerging health issue commonly seen in trafficked individuals is substance abuse. The widespread use of drugs, particularly heroin, among trafficked patients, as Dr. Stoklosa explained, “is because it’s either the traffickers to method of coercing them to work or the survivor’s way of coping with physical and emotional trauma.”  

http://www.acf.hhs.gov/blog/2016/05/human-trafficking-and-opioid-abuse

 

 

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Operation Walk Boston Volunteers Go the Extra Mile

Kara Burge (center), a staff nurse in Orthopaedic Surgery, with two Operation Walk Boston patients
Kara Burge (center), a staff nurse in Orthopaedic Surgery, with two Operation Walk Boston patients

A year had passed since a young man came to the clinic with severe joint disease in his hips that left him unable to stand up straight, his torso pitched forward about 45 degrees as he steadied himself on a crutch.

But thanks in part to a group of volunteer clinicians from the Brigham, he was now running laps up and down a hallway at a hospital in the Dominican Republic, where he had received bilateral hip-joint replacement surgery through Operation Walk Boston—an orthopedic medical mission founded by Thomas S. Thornhill, MD, former chair of the BWH Department of Orthopaedic Surgery.

The program partners with Hospital General de la Plaza de la Salud in Santo Domingo to perform hip- and knee-joint replacements for patients who can’t afford the procedures. It completed its ninth mission in April. Continue reading “Operation Walk Boston Volunteers Go the Extra Mile”

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Emergency Medicine Bedside Ultrasound Training in Kigali, Rwanda

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Kristin Dwyer outside of CHUK Hospital

In this blog post from the Partners Center of Expertise in Global and Humanitarian Health, Kristin Dwyer, MD, MPH, a BWH fellow in Emergency Ultrasound, writes about working with emergency medicine residents for her rotation at University Central Hospital of Kigali (CHUK) in Rwanda.

“As I wrap up my time here, I must say I found it to be a valuable experience,” she writes. “While it is difficult to effect change in a short amount of time, I think having smaller goals is useful. I am not necessarily going to get patients to come to the hospital earlier in their disease course, but I can arm physicians there with ultrasound skills to more accurately diagnosis them when they arrive looking for help.” Read more.

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BWH/BWFH Physicians Teach Minimally Invasive Techniques for Gynecological Surgery in Senegal

Jon Einarsson (left) and James Greenberg (right) pose with a surgeon from Senegal.
Jon Einarsson (left) and James Greenberg (right) pose with a surgeon from Senegal.

Senegal has long been one of the most stable democracies in Africa. However, compared to the United States, physicians there lack many resources. Recently, a team of Brigham physicians traveled to the country’s capital city of Dakar to teach a course in collaboration with the African Center of Excellence for Mother and Child at Cheikh Anta Diop University (also known as the University of Dakar) on minimally invasive techniques for gynecological surgery. Through a series of lectures and live surgeries, physicians taught these techniques, helping the local physicians understand how they might perform them safely with their limited resources.

Brigham and Women’s Faulkner Hospital’s Chief of Gynecology James Greenberg, MD, and Director of the Division of Minimally Invasive Gynecologic Surgery at Brigham and Women’s Hospital and BWFH surgeon Jon Einarsson, MD, were among the group of physicians conducting the week-long course organized by Senegal native and Associate Obstetrician Gynecologist at BWH Khady Diouf, MD. Continue reading “BWH/BWFH Physicians Teach Minimally Invasive Techniques for Gynecological Surgery in Senegal”

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The Zika Virus in Haiti

Dr. Louise Ivers

Many questions remain about Zika and its current impact on the Haitian population. Until more answers surface, BWH and Partners In Health(PIH) staff strive to find the best solutions for women, men, and children who may be adversely affected by the virus.

Louise Ivers, MD, MPH, of the BWH Division of Global Health Equity and senior health and policy advisor for PIH, answers questions about the mosquito’s resiliency, efforts to control it in Haiti and how PIH is working to prevent Zika infections and treat those who might be suffering from complications.

Read the Q&A on the PIH blog.

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MRCT Center Takes on Emerging Issues in Global Clinical Trials

 

MRCT Center staff include, from left, Heather Marino, program manager; Barbara Bierer, faculty co-director; Rebecca Li, executive director; Mark Barnes, faculty co-director; and Carmen Aldinger, program manager.

When Indian regulators implemented a series of new clinical trial regulations in 2013, clinical trials in India ground to a halt. Under the new regulations, clinical trial sponsors would be responsible for compensating participants who were injured or died during the trial, even if the death or injury was unrelated to the trial itself. Virtually all clinical trials sponsors, including the National Institutes of Health, stopped initiating any new trials. Less than two percent of the world’s clinical trials were unfolding in a country that is home to one-seventh of the world’s population. Barbara Bierer, MD, co-director of the Multi-Regional Clinical Trials (MRCT) Center, had been following the dilemma in India closely.

Bierer and Mark Barnes, then at Harvard University, had launched the MRCT Center in 2011 to define and address emerging issues in global clinical trials. By bringing together a variety of stakeholders, the center aims to find solutions to improve the integrity, safety and rigor of trials around the world.

After the new regulations were announced, Bierer and her colleagues reached out to government officials and industry and academic stakeholders in India, organized roundtable discussions and, over the course of more than 14 visits to the country, worked closely with Indian leaders to help to develop fair amendments to the earlier legislation and address the issues resulting from regulatory reform. The MRCT Center has been involved in training, and in developing scalable tools that will assist the appropriate application of the regulations such as a tool to assess causality to determine whether a death or injury is directly linked to a clinical trial. Their efforts continue today.

Read the full story in the February issue of BWH Clinical & Research News.

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Training the First Generation of Neurologists in Haiti

Aaron Berkowitz teaches a neurology course to residents in Haiti.

Haiti has just one neurologist for 10 million citizens, but the burden of neurological disease there is enormous, say BWH’s Aaron Berkowitz, MD, PhD, and Louine Martineau, MD, of the University Hospital in Mirebalais, Haiti.

Since BWH helped the University Hospital open in 2013, Martineau has been regularly consulting on his neurologic patients with Berkowitz, who leads BWH’s Global Neurology Program. “By opening an outpatient clinic in communication with Dr. Berkowitz, we have created a way to manage patients with neurologic problems,” says Martineau.

To address the larger problem, Berkowitz and colleagues are launching Haiti’s first neurology training program. Initial seed funding will allow them to train two neurologists over the next two years.

“With further investment in the fellowship, we hope to train a few neurologists every year,” says Berkowitz. “These neurologists will serve different regions of the country so patients can get the care they need from local providers.”

Read the full story in the Brigham and Women’s magazine (pages 24 and 25).

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How A Checklist Can Help Address Causes of Mother, Infant Death in Childbirth

After years of testing in dozens of countries around the world, the Safe Childbirth Checklist was recently released by the World Health Organization (WHO) in collaboration with Ariadne Labs, a joint center of Brigham and Women’s Hospital and the Harvard T.H. Chan School of Public Health. Scientists at Ariadne Labs helped develop and adapt the checklist and, with Population Services International, are leading the largest randomized controlled trial – called the BetterBirth Program –to test its effectiveness at lowering maternal and neonatal deaths. The BetterBirth Program is implementing the checklist with peer-to-peer coaching and data feedback in more than 100,000 live births across Uttar Pradesh, India.

In this Q&A,  Dr. Katherine Semrau, a Brigham epidemiologist in the Division of Global Health Equity and the Director of the Ariadne Labs BetterBirth Program, tells us more about the Safe Childbirth Checklist.

Katherine Semrau, PhD, MPH
Katherine Semrau, PhD, MPH

How are we doing, globally speaking, when it comes to maternal and neonatal care in childbirth?

Since the establishment of the Millennium Development Goals in 2000, we have made great strides globally in reducing maternal mortality by 43 percent. Unfortunately, reductions in newborn mortality have been marginal; 45 percent of all child mortality occurs in the first 28 days of life. Even with these successes, 303,000 women and 2.9 million newborns die each year. We can do better.

Much of the focus on reducing maternal and newborn mortality has been on improving access to facility-based delivery with a skilled birth attendant in low- and middle-income countries. This approach has improved access to care—but that alone has not solved the problem. Continue reading “How A Checklist Can Help Address Causes of Mother, Infant Death in Childbirth”

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DGHE’s Introduction to Social Medicine Course: Brigham at Its Best

SOLEDAD, CHIAPAS, MEXICO - AUGUST 13, 2015: Dr. Dan Palazuelos, center, talks to bootcamp participants in the community of Soledad.  (Photo by Cecille Joan Avila / Partners In Health)
SOLEDAD, CHIAPAS, MEXICO: Dr. Dan Palazuelos, center, talks to bootcamp participants in the community of Soledad. (Photo by Cecille Joan Avila / Partners In Health)

Every year since 2005, BWH’s Division of Global Health Equity (DGHE) has offered an Introduction to Social Medicine course—jokingly referred to as “GHE boot camp” due to the jam-packed and demanding schedule of activities—in Rwanda or Haiti. The course is a way to introduce new global health equity residents to “global health: the Brigham and Partners In Health (PIH) way,” says BWH hospitalist and course instructor Dan Palazuelos, MD, MPH.

“We discuss many different themes in global health and are able to demonstrate our approach in real time, including how we partner with local governments and communities to achieve high-value clinical outcomes,” said Palazuelos, who is assistant director of BWH’s Hiatt Global Health Equity Residency. “The program is in part a product of the Brigham philosophy of how we treat each other, how we treat patients and why we pursue excellence in training. Like at the Brigham, all PIH sites are dedicated to doing whatever it takes to help patients get healthy again.”

This year, the course was held in Chiapas, Mexico, for the first time. The setting was a familiar one for Palazuelos, who, although having Mexican roots, first stepped foot on Chiapanecan soil in October 2005 as a Hiatt Global Health Equity resident. He originally set out to help with relief efforts after Hurricane Stan devastated the area, but he stayed dedicated to the region and ultimately worked with PIH to launch an entirely new comprehensive primary health care program there. Continue reading “DGHE’s Introduction to Social Medicine Course: Brigham at Its Best”