Global Health Doc Prepares for Boston Marathon

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Robert Riviello shares this picture of himself on a training run in Rwanda for the Boston Marathon.

One of BWH’s global health experts, Robert Riviello, MD, MPH, is training for the Boston Marathon while he is in Rwanda this month. This year’s marathon is especially meaningful to Riviello, as he was working in BWH’s Emergency Department when the bombs exploded at last year’s marathon.

He writes:

Soon afterward, I received an email from a physician I work with on my regular travels to Rwanda that simply said, “Be strong.” This doctor, a survivor of genocide who I have teamed with as a part of BWH’s Center for Surgery and Public Health, was now supporting me in my community’s time of need.

It was a moving reminder that, no matter who you are or what your circumstances, you never know when you’ll need support—or when an encouraging word can mean the world to someone else.

That’s why I’m running in this year’s Boston Marathon—to pay tribute to the community who stood strong and supported each other through last year’s tragic events. And with less than three weeks until Marathon Monday, my teammates and I could all use some words of encouragement right about now.

I’m writing to you now from Rwanda, where I’m continuing my work with Dr. Georges Ntakiyiruta, but I’m still doing my marathon training—and it hasn’t been easy. (That’s me in the photo, training solo here.)

Running up Mount Kigali is always worth it for the great view, but to make it up there I have to motivate myself by remembering why I’m doing this: to honor the courage of our patients and the passion of our care teams.

This year’s Boston Marathon means so much to me and my teammates, and I’m sure it does to you, too. Please sign the good luck card and leave a message that BWH will deliver to our team the day before the race: http://give.brighamandwomens.org/pages/Marathon-Card

Please feel free to share the link far and wide!

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Nurse Volunteers in Dominican Republic

By Courtney Murphy, BSN, RN
Trauma, Burn and Surgical Critical Care Units

From Feb. 22 to March 8, I had an experience of a lifetime. Alongside 24 other registered nurses, I traveled to El Cercado and Cotui, Dominican Republic, on a medical mission with a nonprofit organization called Intercultural Nursing. I had the opportunity and pleasure to provide free health care to some of the poorest people in the Dominican Republic. We treated persons of all ages, from infancy through late adulthood. Many of the men and women I met walked more than two hours to see “the wonderful American nurses.”

During our first clinic day, I met a woman in her 50s who told me she suffered from chronic headaches. After performing a thorough assessment, I decided to give her some Tylenol in addition to the toiletries everyone we saw received. As I handed her a small bottle of Tylenol and began to explain how frequently to take the pain medication, tears began to roll down her cheeks. She told me she has never been able to afford Tylenol and has lived in pain for the past ten years.

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Courtney Murphy is joined by local children who would walk to the clinic after school to visit the nurses.

My heart melted when I saw how appreciative this woman was. To know something as simple as Tylenol was going to make such a huge difference in this woman’s life was a wonderful feeling. For each clinic day that followed, I encountered many more individuals who were so thankful of the care we provided.

As nurses, we make a difference in the lives of strangers each and every day. This opportunity allowed me to change the world, at least for the 800 plus people we saw and treated during my two week mission. I look forward to going on another medical mission in the near future to help even more people and bring smiles to the faces of those in need.

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Another Successful Mission for Operation Walk Boston

The BWH-led Operation Walk Boston team is on its seventh annual mission to the Dominican Republic, performing joint replacements on those in need. This year, the team set its sights on providing joint replacements for 43 patients, with the goal of performing 43 total knee replacements and 18 total hip replacements. Check out photos and blog posts from the team throughout its trip at operationwalkboston.blogspot.com

OpWalk

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New Childhood TB Estimates Double the Number Previously Thought

Researchers from BWH and Harvard Medical School have estimated that around one million children suffer from tuberculosis (TB) annually— twice the number previously thought to have tuberculosis and three times the number that are diagnosed every year.

The researchers also estimated that around 32,000 children suffer from multidrug-resistant tuberculosis (MDR-TB) annually. These findings were published in The Lancet on March 23, 2014.

“Despite children comprising approximately one quarter of the world’s population, there have been no previous estimates of how many suffer from MDR-TB disease,” explained Ted Cohen, MD, DrPH, HMS associate professor of Medicine in BWH’s Division of Global Health Equity and co-senior author of this study. “Our estimate of the total number of new cases of childhood TB is twice that estimated by the WHO in 2011 and three times the number of child TB cases notified globally each year.”

These findings underscore the urgent need for expanded investment in the global response to TB and MDR-TB in children.

“Our findings demonstrate that there is a need for improved methods for collecting data on childhood TB. A good starting place would be improved diagnostic methods for children and more systematic collection of information on how many children are suffering with this disease,” explained Helen Jenkins, PhD, HMS instructor in BWH’s Division of Global Health Equity and lead statistician on the project.

Read more about the study in this article by Fox News.

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Nurse Shares “Eye-Opening” Experience in Cajamarca, Peru

Check In Day (3)

A line of patients and family members waiting to check in for surgery.

By Tiffany Alongi, RN, PCCN
Trauma, Burn and Surgical Critical Care Units

Audrey Hepburn once said, “As you grow older, you will discover that you have two hands- one for helping yourself, the other for helping others.”

As a young, fresh faced graduate I was thrilled to be starting my career in one of the most prominent and cutting edge hospitals in the country. The idea of nursing was something I had always dreamed of doing. However, the complexity of a true nursing position quickly became evident to me. Nursing is an action packed, fast paced, ‘roll with the punches’ type of position that many are ill-equipped for, but I loved everything about it. I was one of those rare people that when asked could honestly say, “I love my job.”

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Tiffany Alongi

Nonetheless, I had begun to feel a growing dissatisfaction. I acknowledged all that I had done here in the states and the impact I had made on some of my patients, but I began to wonder what else I could be doing.  I longed to spread my love for nursing beyond the walls of BWH. Rather than patients coming to me, I wanted to travel to them. I sought to employ my passion, empathy and knowledge on a more international scale in order to help treat patients around the world.

In November 2013, I embarked on a medical mission to Cajamarca, Peru, with an organization known as Medical Mission for Children. MMFC is a nonprofit volunteer based organization which travels to remote geographical locations in order to help children and young adults with the surgical repair of cleft lip and palate deformities, burn injuries, microtia and head or neck tumors. The focus of my mission was to repair cleft lips and palates and dental extractions. Continue reading

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Researchers Study Statin Use in India

Medications—along with diet, exercise, and smoking cessation—are a cornerstone of cardiovascular risk reduction. The use of statins, which are the medication of choice for prevention, has increased substantially in North America and Europe over the past three decades, and as a result, cholesterol levels and cardiovascular mortality have decreased.

But little is known about statin use in lower-income countries. BWH researchers recently conducted an observational study of statin use in India, which has the highest burden of cardiovascular disease among less-developed nations.

The researchers found that only a fraction of those eligible for a statin actually received the therapy, despite the wide variety of statins that are available to Indian consumers.

“Low rates of statin use in India may reflect problems with access to health care, affordability, under-diagnosis, and cultural beliefs,” said Niteesh Choudhry, MD, PhD, of the BWH Division of Pharmacoepidemiology and Pharmacoeconomics, and lead author of the paper. “Because of the growing burden of cardiovascular disease in lower-income countries such as India, there is an urgent need to increase statin use and ensure access to safe products whose use is based on evidence.” Continue reading

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Supporting Medical Education in Haiti

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Dr. Aaron Berkowitz joins Haitian physicians on rounds to assess a patient at Saint Boniface Hospital.

On Jan. 13, 2010, just one day after a devastating earthquake struck the island nation of Haiti, a group of BWH physicians huddled in the Department of Medicine’s Eppinger Conference Room to ask: What can we do to help?

One of them, Michelle Morse, MD, MPH, went to Haiti during her residency in Global Health Equity at BWH. After the earthquake, she met Zadok Sacks, MD, a resident at BWH and Boston Children’s Hospital.

“There was just an incredible energy among people here about doing something and making a contribution together,” said Sacks, who now runs the young adult consult service at Children’s.

Together, Sacks and Morse founded an organization called Physicians for Haiti, which supports the work being done around medical education in Haiti.

“Haiti is full of amazing health care professionals, and they deliver care without access to any of the resources that we have here-the network of colleagues, technology and equipment,” Sacks said. Continue reading

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Video: Memorable Moments from Malawi

In the video below, Emily Wroe, MD, resident physician in the BWH Department of Global Health Equity, shares stories from her global health trips to Malawi. Watch how creative communication and community ties play a role in the patient care she has witnessed first-hand.

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Responding to Typhoon Haiyan

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A rural health unit damaged by typhoon Yolanda.

 

By Shawn D’Andrea, MD
Attending Physician, BWH Emergency Medicine

The week before Thanksgiving, the disaster medicine section of the American College of Emergency Physicians(ACEP) circulated a request for physicians to participate in ongoing humanitarian relief operations in the Philippines in response to  typhoon Haiyan, also known as typhoon Yolanda. On Nov. 27, I arrived at Roxas City on the island of Panay, Philippines, to join a small group of physicians and nurses with a non-government organization engaged in relief efforts.

The group that had sent the request through ACEP, Remote Area Medical (RAM) is a small, all volunteer U.S. medical non-government organization which has functioned in several disaster settings and defines itself as an organization able to access and function in difficult-to-reach and austere settings.  Following typhoon Yolanda, the group partnered with the Philippine Red Cross and later a regional health department on Panay island to support medical needs in the relief effort.  When I arrived shortly before Thanksgiving, RAM, coordinating with the regional health department and other relief organizations, was performing daily missions to the rural areas of Panay island to provide direct medical care to patients in areas affected by the storm. While the regional health department has an extensive network of local health offices and clinics, the storm left the health infrastructure severely damaged.  The role of medical relief organizations, under the direction of the regional health authority, was to assess the health needs of communities following the disaster,  provide direct patient care during relief and recover phases of the disaster, and to provide ongoing disease surveillance. Continue reading

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Global Health Summit Offers Insight, Inspiration

BRIGHAM AND WOMEN'S HOSPITAL AND HARVARD MEDICAL SCHOOL HOST THE GLOBAL HEALTH SUMMIT MONDAY AFTERNOON

From left, Paul Farmer, Atul Gawande and Nawal Nour share a laugh during the keynote panel at the Global Health Summit.

Through the stories and insights shared during the Nov. 25 Global Health Summit, attendees were transported to war-torn Somalia, the mountains of Rwanda and back home again.

Throughout the afternoon, they heard Andrew Ellner, MD, MSc, of BWH’s Division of Global Health Equity, demonstrate the need for an overhaul of the American health care system and Michael VanRooyen, MD, MPH, FACEP, of BWH’s Department of Emergency Medicine, share his personal insights into training the next generation of humanitarian workers.

Attendees listened intently as BWH associate physician Ashish Jha, MD, MPH, asked the poignant question about preventable health care costs: “How is it safe to fly a 30-year-old plane but not use a 6-year-old CT scanner?”

Hosted by BWH, Harvard Medical School (HMS) and Harvard School of Public Health (HSPH), the Global Health Summit—a BluePrint-themed event—provided a thought-provoking inside look at the important work being done in the global health arena. Special guests and BWH, HMS and HSPH leaders and staff came together in the Joseph B. Martin Conference Center at HMS to learn lessons straight from the field from expert physicians, patients and donors in three panels.

“What makes global health work successful is partnership,” said BWH President Betsy Nabel, MD, who provided an introduction and closing for the event’s last panel. “The ability to connect and work together is essential.”

Robert Riviello, MD, MPH, and Daniel Ponton discuss stories from the field in Rwanda.

Robert Riviello, MD, MPH, and Daniel Ponton discuss stories from the field in Rwanda.

In one panel, BWH surgeon Robert Riviello, MD, MPH, of the Division of Trauma, Burns and Surgical Critical Care, shared his inspiration for getting involved in global health work: his Christian faith and growing up reading stories of saints and missionaries.

“That dedication, resilience and effectiveness struck me as, ‘This is ‘good with a capital G’ work – work you would want to spend your life doing,’” he said.

Joining Riviello on the panel was philanthropist and former BWH patient Dan Ponton, who spoke about his partnership with Riviello to build much-needed housing for doctors in Rwanda. Ponton, who was successfully treated at BWH for a life-threatening brain tumor, saw how the housing shortage made it difficult to attract and retain qualified medical staff. His foundation—the Daniel E. Ponton Fund at Brigham and Women’s Hospital—subsequently funded and built the Butaro Doctors’ Housing project.

During the panel, Ponton shared the inspiring message that “it doesn’t always take a doctor to solve a health care problem.”

In the event’s final panel, WBUR “Here & Now” co-host Robin Young spoke with global health luminaries Paul Farmer, MD, PhD, Atul Gawande, MD, MPH, and Nawal Nour, MD, MPH, in what resembled a personal living room conversation among friends.

After providing introductions of each other, the three panelists answered Young’s thoughtful questions, sharing everything from their inspirations to formative moments in their lives and careers—including Farmer’s admission that working in Haiti was his “Plan B.” Plan A was working in West Africa.

Gawande, a self-described “professional dilettante,” or dabbler, said that he has always been interested in change and why it seems so hard. He sees his research and writing as ways to “work through the puzzles and try to solve problems.”

He later summed up the spirit of BWH by saying: “If you’re not leading by making a difference, then you’re not fulfilling the mission of this place.”

Nour discussed her work with the African Women’s Health Center at BWH, which she founded in 1999, and the nuances and complexities of the beliefs held by her patients, many of whom have experienced female genital cutting.

Of the media’s flashing interest and coverage of women’s and children’s health issues, Nour said: “If we could sustain that interest and funding, we could make changes systematically. If more people looked at health issues through a gender-based lens, we could make great improvements.”

View a photo gallery from the event.

Watch webcasts of the panel discussions:
“The Global Health Experience: What We Can Learn”
Introduction and moderation: Jeffrey Flier, MD
Panelists: Andrew Ellner, MD, MSc, Ashish K. Jha, MD, MPH, Michael VanRooyen, MD, MPH, FACEP

“Making Global Health Happen”
Introduction and moderation: Julio Frenk, MD, PhD, MPH
Panelists: J. Christopher Flowers, Dyann Wirth, PhD, Daniel E. Ponton, Robert Riviello, MD, MPH

“To Alleviate Human Suffering: Our Work to Strengthen Global Healthcare”
Introduction: Elizabeth G. Nabel, MD
Moderation: Robin Young
Panelists: Paul Farmer, MD, PhD, Atul Gawande, MD, MPH, Nawal Nour, MD, MPH
Closing: Elizabeth G. Nabel, MD

 

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