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.

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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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BWHers Examine Reparation Program in Colombia

Written by Patrick Vinck, PhD, of BWH Emergency Medicine, assistant professor, Harvard Medical School, Harvard T.H. Chan School of Public Health, and associate faculty with the Harvard Humanitarian Initiative.

Phuong Pham, PhD, MPH, of BWH Emergency Medicine and collaborators present their findings to Colombian President Juan Manuel Santos and more than 20 high-level officials.

Phuong Pham, PhD, MPH, of BWH Emergency Medicine and collaborators present their findings to Colombian President Juan Manuel Santos and more than 20 high-level officials.

After conducting a systematic evaluation of Colombia’s reparation program from September 2014 through May 2015, Phuong Pham, PhD, MPH, of BWH Emergency Medicine, associate faculty member with the Harvard Humanitarian Initiative and a research scientist at the Harvard School of Public Health, recently presented findings from the evaluation to the country’s president Juan Manuel Santos.

The U.S. Agency for International Development and Management Systems International contacted the Carr Center for Human Rights Policy at the Harvard Kennedy School in Cambridge, as well as Phuong and I, about working in Colombia, based on our previous experience with assessing how victims of armed conflicts and communities rebuild their lives after violence, including the role of transitional justice. Continue reading

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Operation Walk Boston Medical Students Receive Prestigious Grant

Devine, Christopher - portrait 1

Chris Devine

Yu, Amy picture

Amy Yu

Chris Devine and Amy Yu, first-year M.D. candidates at Harvard Medical School, have been awarded the Rheumatology Research Foundation’s Medical Student Preceptorship, a prestigious, competitive award to advance their research conducted during the Operation Walk Boston 2015 mission.

Devine and Yu work under the guidance of Dr. Jeffrey N Katz, Operation Walk Boston Director of Outcomes Research and  Director of the Orthopaedic and Arthritis Center for Outcomes Research (OrACORe) at Brigham and Women’s Hospital. Devine and Yu are leading qualitative research projects to understand cross-cultural differences in clinicians’ pain management practices and patients’ perception of pain. Continue reading

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After earthquake, a vision for Nepal’s future

BWH’s Duncan Maru, MD, PHD, of the Division of Global Health Equity, was in Nepal working with Possible to strengthen health care systems in the region when a record-breaking earthquake struck on April 25. Since then, Maru has been involved with Nepal’s post-earthquake planning and response efforts, while continuing to strengthen the health system in Nepal.

Maru recently co-authored two pieces with senior Nepali government officials about Nepal’s health care system. In the Washington Post, “Building back better after an earthquake” explores the global response to the earthquake, and how to leverage this influx of assistance to sustainably strengthen infrastructure in the country.

“Access, excess and medical transformation: Delivering durable health care in Nepal,” appearing in the Health Affairs Blog, describes some of the challenges and inequalities in Nepal’s health care sector, and proposes a new Durable Healthcare Organization model for care. This model “blends the access and scale of the public sector, the customer orientation and management practices of the private sector, and innovation of philanthropists and academics.”

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Building Research Capacity in Rwanda, One Student at a Time

Rwanda research

There’s a popular saying, “Give a man a fish and you feed him for a day; teach a man to fish and you feed him for a lifetime.”

When Shilpa Murthy, MD, MPH, and John Scott, MD, MPH, were approached about giving a lecture to medical students about research methods as part of their global health work in Rwanda, they knew they needed to push for something longer-lasting; they needed to teach and not just give. “We knew that for change to be sustainable, it would have to come from within,” explained Murthy, a general surgery resident and research trainee at the Center for Surgery and Public Health (CSPH) at Brigham and Women’s Hospital (BWH).

Read the full story here in BWH Clinical & Research News.

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Making Good on a Promise Made to the People of Haiti

 

Dr. George Dyer, an orthopedic surgeon at Brigham and Women's Faulkner Hospital, speaks in Haiti.

Dr. George Dyer, an orthopedic surgeon at Brigham and Women’s Faulkner Hospital, speaks in Haiti.

Over the course of the last five years, Brigham and Women’s Faulkner Hospital orthopedic  surgeon Dr. George Dyer has traveled to Haiti 14 times. His commitment to the country began immediately following the 2010 earthquake when he signed up to travel there with Partners in Health. His mission then and now has been to help train skilled orthopedic surgeons.

Reflecting on his first trip to Haiti in the aftermath of the earthquake Dr. Dyer says, “It was very rewarding. We did a lot of good. But as the two weeks that I was there wore on it, it was clear that the earthquake was really only a small blip in the number of orthopedic injuries that overwhelm the local capacity of surgeons in Haiti.” At the time there were just 40 orthopedic surgeons in a country of 12 million.

With the support of the American Academy of Orthopaedic Surgeons and their generous grant, Dr. Dyer and his colleagues have worked tirelessly to foster an interest in orthopedics in young Haitians and help them get the training they need to practice their profession. They organize orthopedic training for residents and also fully trained orthopedists in Haiti.  They bring visitors to Haiti to teach local physicians on the ground. They organize an annual conference. And they bring their Haitian colleagues out of the country to go to the US or elsewhere for training courses and to see techniques that are not taught anywhere in Haiti. Continue reading

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