The Poorest Billion

The poorest billion people in the world do not have access to quality health care, including preventive services, says Paul Farmer, MD, PhD, BWH’s chief of the Division of Global Health Equity. ]

In this video,  Farmer announces a new Clinton Global Initiative commitment by Partners In Health and The Lancet to address non-communicable diseases among the poorest billion.

Video via the Clinton Global Initiative

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Addressing Inequities in Pregnancy Care and Childbirth in Chiapas, Mexico

Andrea and Rose Jalte

Rose Molina, BWH Connors Center Global Women’s Health Fellow, and Andrea Reyes, Maternal Health Coordinator at Compañeros en Salud

By Rose Molina, MD
BWH Connors Center Global Women’s Health Fellow

The motto of every pregnancy sounds simple: “healthy mom, healthy baby.” Yet, pregnancy and childbirth remain important causes of morbidity and mortality for reproductive-age women in resource-limited settings.

While the conversation about increasing Cesarean delivery rates and “medicalization” of childbirth in the United States continues, the reality in Chiapas, Mexico, is strikingly similar yet a world apart; both under-intervention and over-intervention exist, creating significant inequities in obstetric care. In Chiapas, the lack of access to quality services remains common for marginalized women, and “medicalization” can lead to “obstetric violence,” a term used to describe disrespect and abuse during childbirth. Continue reading

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Recent Studies Demonstrate Ways to Improve Quality of Care and Reduce Costs

Thomas Gaziano

With a theme of “Noncommunicable Diseases: The Growing Burden,” the latest issue of Health Affairs features two studies co-led by BWH’s Thomas Gaziano, MD, of the Cardiovascular Division, and a team of authors.

The first study finds that cardiovascular disease screening by community health workers can be cost-effective in low resource countries. Understanding that a physician is not always available in low-resource settings, the authors demonstrated that community health workers can efficiently screen adults for cardiovascular disease in South Africa, Mexico and Guatemala. By using a paper-based or mobile phone-based screening tool that does not require blood testing, community health workers could conduct screenings in a cost-effective, or even cost-saving, manner in all three countries, compared to the usual clinic-based screening. “Our modeling indicated that screening by community health workers, combined with improved treatment rates, would increase the number of deaths averted from 15,000 to 110,000, compared to standard care,” write the authors.

The second study investigates the health and economic impacts of increasing prescription length for statins in South Africa, where the rates of statin use are among the lowest in the world.   “Almost five percent of the country’s total mortality has been attributed to high cholesterol levels, fueled in part by low levels of statin adherence,” write the authors.

They found that increasing prescription length from the standard 30 days to 60 or 90 days could save 1,694 or 2,553 lives per million adults, respectively. In addition, annual per patient costs related to cardiovascular disease would decrease by $152.41 and $210.29, respectively. “Increasing statin prescription length would both save resources and improve health outcomes in South Africa,” conclude the authors.

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Maru’s Efforts in Nepal Highlighted by NIH


Duncan Maru

Dr. Francis Collins, director of the National Institutes of Health, recently wrote a blog post highlighting Duncan Maru, MD, PhD, of the BWH Division of Global Health Equity, and his work in Nepal. In 2008, Maru co-founded Possible, a non-governmental organization that manages the health care system of Accham (a rural district of Nepal) through a public-private partnership with Nepal’s Ministry of Health and Population.

Maru has dedicated his career to developing innovative ways of delivering high-quality, low-cost care in developing areas of the world. He hopes that the work he is doing in Accham with Possible will ultimately help create a model to revitalize health care systems in Nepal and under-resourced settings around the world.

Read the blog post, “Creative Minds: Lessons from Halfway Around the Globe,” here.

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BWH Employee Organizes Aid for Dominica

Petite-Savanne-evacuees (2)On Aug. 27, the tiny nation of Dominica was devastated by a tropical storm that dropped more than 15 inches of rain on the island. Landslides and massive flooding ensued, killing more than 30 people and leaving hundreds homeless.

“This is a significant blow to any island, particularly one with about 70,000 people,” says Shirma Pierre, administrative director for BWH’s Center for Community Health and Health Equity. “The infrastructure has been crippled, and it is estimated that the storm has set Dominica’s development back 20 years.”

Pierre, who was born in Dominica and grew up there, is responding to the call for assistance along with other members of the Dominican community in Boston. The relief effort, “Boston for Dominica,” will provide assistance towards high priority needs of people in Dominica affected by the storm. The group is working with the government of Dominica to facilitate the collection and distribution of items that are deemed priority. Continue reading

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Improving Access to Healthcare in Nepal

Since 2008, Possible (formerly known as Nyaya Health) has been committed to delivering high-quality, low-cost healthcare to the people of Nepal. The non-governmental organization was founded by a group that includes Duncan Maru, MD, PhD, and brothers Ryan Schwarz, MD, MBA, and Dan Schwarz, MD, MPH, who are former or current residents with the Doris and Howard Hiatt Residency in Global Health Equity and Internal Medicine for Brigham and Women’s Family Care Associates at Brigham and Women’s Faulkner Hospital.

Cracked walls of the Bhirkot Health Post that was damaged during the earthquake and  will be one of the health posts rebuilt by Possible in 2015.

Cracked walls of the Bhirkot Health Post that was damaged during the earthquake and
will be one of the health posts rebuilt by Possible in 2015.

Nepal is one of the world’s poorest countries, but it also has some of the most progressive healthcare policies. The country’s constitution guarantees the right to health and universal healthcare for the poor. However, in rural areas, millions don’t get the care they need from the traditional private, public and philanthropic approaches to healthcare. That’s where Possible and its durable approach to healthcare come into play. Durable healthcare is a public–private partnership that enables a nonprofit healthcare company to be paid by the government to deliver healthcare within the government’s infrastructure.  It brings together the quality of the private sector, access of the public sector and innovation enabled by philanthropy. Core financing is tied to performance. Read the full story.

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BWH Nurse Mentors Partner with Haitian Nurses to Improve Care

A group of dedicated BWH nurses are helping to make a lasting impact on patient care, nursing education and scholarship in Haiti through a unique mentorship program.

Every summer for the past five years, the BWH Nursing department has hosted cohorts of nurses from Haiti for four days, pairing them with BWH nurses on patient care floors, who serve as mentors. This initiative is part of the International Nurse Faculty Partnership called the Regis College Haiti Project, a collaboration between the Regis College School of Nursing, Science and Health Professions, Partners In Health (PIH), Haiti’s Ministry of Health, and Haiti’s State University that strives to improve access to quality health care in Haiti by addressing the acute nursing shortage and the call for advancement of nursing education.

Nurses from Haiti visit BWH

In June, BWH welcomed Haitian nurse educators to CWN 9 for four days of clinical shadowing and discussion.

The rigorous education and leadership program is offered to Haitian nursing faculty across Haiti, who enroll in the master’s of Nursing program at Regis and spend time in clinical settings as part of their learning experience. “Spending time in a clinical setting is absolutely essential to learning,” said Patrice Nicholas, DNSc, DHL (Hon.), MPH, MS, RN, ANP, FAAN, director of Global Health in the BWH Center for Nursing Excellence.

Continue reading

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Community Trust and the Ebola Endgame

What must be done in order to end the Ebola epidemic?

BWH’s Ranu Dhillon, MD, and J. Daniel Kelly, MD, of the Wellbody Alliance, co-authored a perspective piece in the New England Journal of Medicine to propose some answers to this pressing question, focusing specifically on Guinea.

The doctors outline the importance of gaining trust and enhancing community respect for response efforts as Ebola teams engage with communities and try to end the epidemic. In the article, they explain how community distrust, rooted in recent decades of misrule and political tumult, enables Ebola to persist. They write:

“In Guinea, community distrust enables Ebola to persist in areas where people continue to hide the sick, conduct funerals in secret, and elude contact tracing…We need to build trust with communities and enhance their respect for response efforts if we are to overcome these challenges and bring the epidemic to an end. Communities are not uncooperative because they are backward or uneducated. On the contrary, they harbor a distrust of Ebola response efforts that is completely rational, given their experience during recent decades of misrule and political tumult…”

Read the full perspective, called “Community Trust and the Ebola Endgame,” in the New England Journal of Medicine.

Ranu Dhillon, MD, is a member of the BWH Division of Global Health Equity and an advisor to the president of Guinea on the Ebola response. J. Daniel Kelly, MD, is the co-founder of Wellbody Alliance, which works alongside Partners In Health in Sierra Leone.

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Exploring Healthcare Delivery at Indian Health Service, Navajo Nation

IMG_2810Working at the Indian Health Service (IHS) in Gallup, New Mexico brought new meaning to the concept of health care delivery for Shubha Bhat, MD, a resident in Brigham and Women’s Hospital’s Department of Medicine. Throughout her time with IHS, Bhat gained new insights, such as the importance and need for the integration of behavioral health within primary care, as well as how to effectively utilize Naltrexone, an opioid antagonist used to manage alcohol dependence.

A house in Navajo Nation.

A house in Navajo Nation.

Her presentations during Infectious Disease Rounds and Intensive Care Unit Rounds at the Gallup Indian Medical Center illustrated her successes, as she discussed her findings after caring for a particularly complex patient to a team of physicians and care providers. At the conclusion of her first week, she had gained a better understanding of the nuances in treating latent and active TB, and how to monitor for drug side effects.   Continue reading

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Learning the Depth of “Whatever it Takes”

Written by Alexi Matousek, MD, MPH, an Arthur Tracy Cabot Fellow and Global Health Equity in Surgery resident at BWH. 

Matousek with Emanes Baptiste, a patient in the surgical accompaniment program.

Alexi Matousek, MD, MPH with Emanes Baptiste, a patient in the surgical accompaniment program.

The cornerstone of global health at Brigham and Women’s Hospital is the longstanding connection with Partners In Health (PIH) – the NGO founded by Paul Farmer. A key component to the mission of PIH is to “do whatever it takes to make [our patients] well – just as we would do if a member of our own families or we ourselves were ill.”

This philosophy is what drew me to the Brigham and to the Department of Surgery, which established a specialized residency track in global surgery. I have spent more than 20 years working on development projects in Haiti with my family, and finding a training program where I could further develop skills in public health and surgical practice among the poor was extremely important to me. I was fortunate to land a research fellowship at the Center for Surgery and Public Health, affording me the opportunity to return to Haiti and bring a new skill set to bear on the problems of access and outcomes measurement in global surgery and begin to discover what it truly means to do “whatever it takes.” Continue reading

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