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Better Counting Preterm Babies: BWH authors’ new review examines what works, and what’s next globally

Anne CC Lee, Lian Folger, Lauren Schaeffer, Pratik Panchal, Hannah Blencowe, Joy E Lawn
Nov 17, 2017 is World Prematurity Day. The authors publication on diagnostic accuracy in neonatal assessment was released today in Pediatrics.

On World Prematurity Day, findings from a new study will be published in the journal Pediatrics.1 This systematic review examines the accuracy of different newborn assessments to determine gestational age and identify preterm babies.

WHY THE EARLY IDENTIFICATION OF PRETERM BABIES IS IMPORTANT

Each year, 15 million babies are estimated to be born preterm (before 37 completed weeks gestation), with the vast majority born in low- and middle-income countries (LMICs).2 Preterm birth complications are the leading cause of under-5 child mortality globally3—accounting for 1 million neonatal deaths each year.4

Preterm babies are more likely to die in infancy or become ill with conditions that could be effectively treated if identified early, such as breathing problems, infections, or low body temperature.   The early identification of preterm babies enables health workers to offer these babies special care, including better monitoring and the timely delivery of potentially life-saving interventions, such as continuous positive airway pressure or kangaroo mother care. Furthermore, accurate determination of gestational age is needed to identify growth-restricted infants, who also carry increased risk of mortality and morbidity in infancy and beyond.

In order to save lives of premature and growth-restricted infants in LMICs, these high-risk infants need to be accurately identified as early as possible and targeted for interventions.
Continue reading “Better Counting Preterm Babies: BWH authors’ new review examines what works, and what’s next globally”

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BWH Global Health Equity faculty and PIH colleagues unveil toolkits for costing and mentored quality improvement in resource limited settings

The original version of the article was posted by Partners in Health

In 2009, BWH faculty in the Division of Global Health Equity began a journey with colleagues in Rwanda, at Partners In Health and at HMS, to strengthen community health across the globe. That journey culminated this fall, with the publication of dynamic toolkits on MESH-QI and District Costing Methodology that will allow the impact of this work to endure. Funded by the Doris Duke Charitable Foundation’s Africa Health Initiative, this ambitious work is coming to a successful conclusion and culminating with numerous publications, notably including two powerful toolkits that will allow this work to be replicated at many sites for years to come.

Dr. Lisa Hirschhorn and Dr. Peter Drobac were principal investigators on the Population Health Implementation Training project, which sought to make significant improvements to WHO health system building blocks. The project also worked to fulfill MOH priorities such as improving the quality of health center-based care, strengthening monitoring and evaluation, and enhancing community health worker networks.

Out of this grant and the vision of these leaders, Partners In Health has developed a model for mentoring health care workers. The model is gaining broad attention after improving quality of care in Rwanda and elsewhere for several years. The team also has developed a new guideline—along with a separate, cost-analysis toolkit—that describes how health centers and systems can implement the model, combat the global shortage of quality health care staffing and plan budgets across a range of services.

“Building a culture of high-quality care delivery processes and systems is almost impossible, especially in resource-limited settings,” said Anatole Manzi, director of clinical practice and quality improvement for PIH, who worked closely with Drs. Hirschhorn and Drobac on this project.

“This guide provides invaluable help to organizations and governments preparing to implement MESH-QI as a model for Health Systems Strengthening,” Anatole Manzi, director of clinical practice and quality improvement for PIH.

Continue reading “BWH Global Health Equity faculty and PIH colleagues unveil toolkits for costing and mentored quality improvement in resource limited settings”

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Partnership to increase access to Cervical Cancer Screening in Uganda

Naima Joseph, MD

Dr. Naima Joseph is a Global Women’s Health Fellow at BWH. Through her research and clinical practice around issues of cervical screening, Dr. Joseph is contributing towards improving cancer related morbidity worldwide and improving healthcare for women.

Rights to quality health care sign on the Kampala-Masaka Road, Mpigi, Uganda

On Kampala-Masaka road, approximately 420 kilometers from Kampala, Uganda’s capital city, lies the Equator. The Equator is in Kayabwe, a bustling village in Mpigi District, and is a known as a destination of sorts. There, you can conduct scientific experiments to estimate the Coriolis effect, or earth’s rotational forces on weather. You can weight yourself and find that you are one lb. lighter on either side. And of course, you can buy souvenirs, or a latte. My favorite stop along the Equator is a seemingly innocuous billboard that boldly proclaims, “You have rights to quality health care.”
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Dr. Keshavjee Pushes the Boundaries of Tuberculosis Care with the Zero TB Initiative

by Brittany Stopa

Brittany Stopa is a Clinical Research Regulatory Coordinator in the BWH Department of Neurosurgery, and she holds a Masters of Public Health in Global Health. She is a contributor to the BWH Global Health Hub.

Dr. Salmaan Keshavjee, Associate Professor, Division of Global Health Equity, Brigham and Women’s Hospital

The BWH Global Health Delivery Partnership Grand Rounds, offered monthly, are open to all staff and clinicians at BWH. I attended the September 2017 Grand Rounds where Dr. Salmaan Keshavjee captivated an audience of global health and health equity supporters with his talk about the Zero TB Initiative. In addition to his appointment as Associate Professor in the BWH Division of Global Health Equity, Dr. Keshavjee serves as Director of Harvard Medical School Center for Global Health Delivery-Dubai and Associate Professor in the Department of Global Health and Social Medicine, at Harvard Medical School.

Dr. Keshavjee had our attention immediately when he declared that there are 10.4 million new cases of tuberculosis (TB) each year, but only 6.1 million of them are diagnosed and treated. Further, 1.8 million of those cases result in death each year, making TB the biggest infectious killer of adults globally. That’s a staggering 4,000 people each day that die from TB, a disease that has been treatable since 1947.

“TB is the biggest infectious killer of adults globally. A staggering 4,000 people each day die from TB, a disease that has been treatable since 1947.”

Continue reading “Dr. Keshavjee Pushes the Boundaries of Tuberculosis Care with the Zero TB Initiative”

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In Nepal BWH Women’s Health Fellows assess gaps in service delivery and reproductive rights

Wan-Ju Wu, MD, MPH is a Connors Center Global Women’s Health/Family Planning Fellow

Through the Global Women’s Health/Family Planning Fellowship I have had the opportunity to work with Possible, a nonprofit organization in Nepal, on community-based interventions to improve uptake of postpartum contraception. With my colleague, Sheela Maru, who also completed the Fellowship I have recently focused on critical issues of access to family planning and safe abortion care.

In 2009 the Supreme Court of Nepal found that reproductive rights are considered to be an inseparable part of women’s human rights and within that, the right to abortion is seen to hold an important place.(Lakshmi Dhikta v. Nepal, Supreme Court of Nepal). Prior to 2002, Nepal had very restrictive abortion laws that prosecuted and imprisoned women and their family members for undergoing pregnancy terminations. Now 15 years after legalization, Nepal is an important case study on successful early implementation of safe abortion services, but persistent challenges exist in issues of access, equity, and quality. 

“In 2009 the Supreme Court of Nepal found that reproductive rights are considered to be an inseparable part of women’s human rights.”

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Community Care with a Global Reach

Dr. Ronald Warner is a primary care physician at Brigham and Women’s Faulkner Community Physicians in Hyde Park. He is President of the Brigham and Women’s Faulkner Medical Staff.

Dr. Warner and medical assistant Felecia Gooding collaborate at the Brigham and Women’s Faulkner Community Physicians in Hyde Park.

As a community physician in the Hyde Park office of Brigham and Women’s Faulkner Community Physicians, I see patients who were born and raised in Hyde Park as well as a large patient population from all over the world who have settled in the neighborhood. While global health often involves a physician traveling to other parts of the world, my patients come from across the city with deep roots to many countries. It’s an honor to connect with patients and their families, to understand the contexts of their lives outside the walls of our office.

Our patient population is a mix of individuals from very different backgrounds and for me personally it’s always interesting and important to hear how they came to us and what they’re doing. Marc and Monique are two of my patients who were born in Haiti and now live in Jamaica Plain. Their lives are not easy given their heath status. Marc has Parkinson’s disease and Monique has COPD. They both also have diabetes. Their complex medical conditions mean their health needs close monitoring. Luckily, their daughter Mirlande lives nearby and is able to help coordinate their care with my office and myself.

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BWH/MGH Emergency Medicine Resident studies point of care Ultrasounds in Columbia

Alister Martin, a second year resident in the Harvard Affiliated Emergency Medicine program, traveled to Columbia with a  Partners Center of Expertise Global Health grant.

martin a_1e

He had three goals upon arrival:
1) doing shifts in the emergency department at a local hospital here,
2) executing our research project on the utilization of point of care ultrasound with the goal of investigating potential behavioral economics interventions to increase its use among emergency department residents, and
3) taking full immersion Spanish classes.

How would he fit that into four short weeks?

Read the answers in the  Partners Center of Expertise in Global and Humanitarian Health Blog,




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Partners Center of Expertise Global Health Symposium: residents focus on global career paths

Anne Rigg, Partners Graduate Medical Education
Jennifer Goldsmith, BWH Division of Global Health Equity

The Partners Centers of Expertise for residents and fellows offer enrichment opportunities in the areas of Global and Humanitarian Health, Quality and Safety, Medical Education, and Health Policy and Management.  Established in 2009, the Center of Expertise in Global and Humanitarian Health offers travel grants and monthly faculty-led dinner sessions focused on global health topics and career development.  On November 12, 2016 the Center of Expertise in Global and Humanitarian Health hosted its inaugural Global Health Symposium.GH symposium 2016_3

Drs. Geren Stone, Mrak Siedner and Serena Koenig on the Global Health Research Careers Panel

The Global Health Symposium was developed by Drs. Joe Rhatigan and Geren Stone.  Dr. Rhatigan serves as Associate Chief of Global Health Equity at BWH and Residency Director of the BWH Howard and Doris Hiatt Residency in Global Health Equity.  Dr. Stone is the Director of the Global Medicine Program at the Massachusetts General Hospital and actingMGH co-leader of this COE.  Dr. Rhatigan was enthusiastic about the full day program for trainees. “The range of experience in global health at Partners is exceptional.  Creating a unified day where trainees could interact with these leaders and one another seemed like a terrific and effective way to draw from the strengths of our community.”

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BWH Haiti Administrative Fellowship Fosters Pharmacy Quality Improvement at Hopital Universitaire de Mirebalais

Jennifer Goldsmith
Director of Administration, Division of Global Health Equity
3 November 2016

Read more about Samahel’s work and collaboration with BWH in Pharmacy Today.

Although I have visited the Hôpital Universitaire Mirebalais (HUM) in Haiti before, my latest trip there marked the first time I received a behind-the-scenes look at its pharmacy. The impact that access to prescription drugs has on the lives of the hospital’s patients cannot be understated and it is made possible by the significant effort put into organizing medications and treatments, which is key to the pharmacy’s efficiency. Inventory management and supply chain are highly specialized operations distinct from the biochemical side of pharmacy work.

I was in the Mirebalais pharmacy in my role as fellowship director for the Walton Global Health Administration Fellowship, which was established in 2014 in BWH’s Division of Global Health Equity. Several generous BWH donors envisioned a program that would build on the existing bonds between BWH, Partners In Health (PIH) and PIH’s Haiti-based organization Zanmi LaSante (ZL). Through the fellowship, ZL administration and leadership would build skills to match the needs of a new 300-bed teaching hospital that was built in the aftermath of the devastating 2010 earthquake. To date, six fellows have participated in the program; among them is Samahel Joseph, director of Pharmacies at HUM.

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BWH Continues as partner in building provider capacity and health equity in Rwanda

From BWH Bulletin 8/26/16 by Jessica Zimmerman
16_08-pf_im_hrh Traumatized by years of civil war and a devastating act of genocide in the early 1990s, Rwanda used to be a place where hope was in short supply.

Over time, however, the country came back stronger than ever—investing in education, infrastructure and regional trade—and Rwanda’s economy enjoyed one of the largest growth rates in the world last year. Still, one critical resource remained scarce: health care.

In 2010, the World Health Organization reported that Rwanda had one of the lowest rates of physicians per capita in the world. A country of nearly 11 million people, Rwanda was home to about 600 physicians at that time. Most were concentrated in large cities like Kigali, leaving rural areas underserved, especially in terms of specialists. Continue reading “BWH Continues as partner in building provider capacity and health equity in Rwanda”