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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After Earthquake, BWHers Coordinate Relief Efforts in Nepal


BWH’s Duncan Maru, MD, PhD, of the Division of Global Health Equity

When an earthquake struck Nepal on Saturday, April 25, two Brigham and Women’s Hospital faculty members were in Achham District, in the far west of Nepal, about  200 miles from the epicenter. Duncan Maru, MD, PhD, and Dan Schwarz, MD, MPH, both of the BWH Division of Global Health Equity, were in Nepal working for Possible, a partner program of the Division of Global Health Equity based in Achham District. The staff at Possible felt the earthquake’s powerful tremors and aftershocks, but fortunately all are safe. As lines of communication were re-established later in the weekend, Possible’s staff members communicated with family and friends in other parts of Nepal, all of whom were thankfully safe. While Achham District gracefully sustained itself through the earthquake with no reported loss of life, buildings, or farmland, the same cannot be said for the rest of the country.

Dan Schwarz

BWH’s Dan Schwarz, MD, MPH, of the Division of Global Health Equity

The death toll now stands at over 5,000 and more than 10,000 have been injured in this country of 30 million. These numbers will climb in the coming days as rescue teams reach the more rural districts closer to the earthquake’s epicenter. These areas were already marginalized prior to the earthquake, and the media has paid little attention to them so far. Preliminary reports on social media and from various local organizations indicate that up to 80-90% of homes and buildings have been destroyed in some communities in Gorkha, Lamjung, and Sindhupalchowk Districts, among others. The scope of the devastation is astounding. Continue reading

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Eight Years of Changing Lives: Operation Walk Boston

Abel Rodriguez gets back on his feet after hip replacement surgery.

For five years following a traumatic injury, 20-year-old Abel Rodriguez, of the Dominican Republic, experienced excruciating pain in both of his hips, forcing him to walk hunched over with crutches. Xiomara Concepcion, a 34-year-old woman suffering from rheumatoid arthritis and bilateral knee pain since adolescence, required a wheelchair to get around.

Rodriguez and Concepcion are among 39 patients whose lives were transformed last month when they received joint replacements, thanks to Operation Walk Boston.

For one week in March, a team of more than 50 volunteers, including surgeons, anesthesiologists, nurses, physical therapists and operating room staff traveled to the Hospital General de La Plaza de la Salud in Santa Domingo for Operation Walk Boston’s eighth mission. The BWH-led team performed 56 knee and hip replacements. Additionally, 58 volunteer medical students from the Dominican Republic cared for patients as part of the team’s goal of educating the next generation of health care professionals in the country.

Read the story in BWH Bulletin and visit Operation Walk Boston for more information.

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Slowing the Spread of Cholera

The Crisis in Haiti

Louise Ivers leading earthquake relief efforts in Haiti in 2010; at right, caring for a young patient at a clinic in Haiti.

Louise C. Ivers, MD, MPH, and colleagues published a paper that shows exactly how much the vaccine Shanchol slowed the spread of cholera in villages north of St. Marc, Haiti, in 2012.

Writing in The Lancet Global Health online, Ivers, the senior health and policy adviser at Partners In Health, finds that Shanchol was widely effective when administered to thousands of adults and children in the region. “We found that there were about 65 percent fewer cholera cases among people that were vaccinated than there were in those

that were unvaccinated,” says Ivers, who is a member of BWH’s Division of Global Health Equity in the Department of Medicine.

It’s fantastic news, and not just for the obvious reason that fewer cholera cases means fewer cholera fatalities. Read the original story on the Partners In Health website.

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