In this blog post from the Partners Center of Expertise in Global and Humanitarian Health, Kristin Dwyer, MD, MPH, a BWH fellow in Emergency Ultrasound, writes about working with emergency medicine residents for her rotation at University Central Hospital of Kigali (CHUK) in Rwanda.
“As I wrap up my time here, I must say I found it to be a valuable experience,” she writes. “While it is difficult to effect change in a short amount of time, I think having smaller goals is useful. I am not necessarily going to get patients to come to the hospital earlier in their disease course, but I can arm physicians there with ultrasound skills to more accurately diagnosis them when they arrive looking for help.” Read more.
Senegal has long been one of the most stable democracies in Africa. However, compared to the United States, physicians there lack many resources. Recently, a team of Brigham physicians traveled to the country’s capital city of Dakar to teach a course in collaboration with the African Center of Excellence for Mother and Child at Cheikh Anta Diop University (also known as the University of Dakar) on minimally invasive techniques for gynecological surgery. Through a series of lectures and live surgeries, physicians taught these techniques, helping the local physicians understand how they might perform them safely with their limited resources.
Many questions remain about Zika and its current impact on the Haitian population. Until more answers surface, BWH and Partners In Health(PIH) staff strive to find the best solutions for women, men, and children who may be adversely affected by the virus.
Louise Ivers, MD, MPH, of the BWH Division of Global Health Equity and senior health and policy advisor for PIH, answers questions about the mosquito’s resiliency, efforts to control it in Haiti and how PIH is working to prevent Zika infections and treat those who might be suffering from complications.
When Indian regulators implemented a series of new clinical trial regulations in 2013, clinical trials in India ground to a halt. Under the new regulations, clinical trial sponsors would be responsible for compensating participants who were injured or died during the trial, even if the death or injury was unrelated to the trial itself. Virtually all clinical trials sponsors, including the National Institutes of Health, stopped initiating any new trials. Less than two percent of the world’s clinical trials were unfolding in a country that is home to one-seventh of the world’s population. Barbara Bierer, MD, co-director of the Multi-Regional Clinical Trials (MRCT) Center, had been following the dilemma in India closely.
Bierer and Mark Barnes, then at Harvard University, had launched the MRCT Center in 2011 to define and address emerging issues in global clinical trials. By bringing together a variety of stakeholders, the center aims to find solutions to improve the integrity, safety and rigor of trials around the world.
After the new regulations were announced, Bierer and her colleagues reached out to government officials and industry and academic stakeholders in India, organized roundtable discussions and, over the course of more than 14 visits to the country, worked closely with Indian leaders to help to develop fair amendments to the earlier legislation and address the issues resulting from regulatory reform. The MRCT Center has been involved in training, and in developing scalable tools that will assist the appropriate application of the regulations such as a tool to assess causality to determine whether a death or injury is directly linked to a clinical trial. Their efforts continue today.
Haiti has just one neurologist for 10 million citizens, but the burden of neurological disease there is enormous, say BWH’s Aaron Berkowitz, MD, PhD, and Louine Martineau, MD, of the University Hospital in Mirebalais, Haiti.
Since BWH helped the University Hospital open in 2013, Martineau has been regularly consulting on his neurologic patients with Berkowitz, who leads BWH’s Global Neurology Program. “By opening an outpatient clinic in communication with Dr. Berkowitz, we have created a way to manage patients with neurologic problems,” says Martineau.
To address the larger problem, Berkowitz and colleagues are launching Haiti’s first neurology training program. Initial seed funding will allow them to train two neurologists over the next two years.
“With further investment in the fellowship, we hope to train a few neurologists every year,” says Berkowitz. “These neurologists will serve different regions of the country so patients can get the care they need from local providers.”
After years of testing in dozens of countries around the world, the Safe Childbirth Checklist was recently releasedby the World Health Organization (WHO) in collaboration with Ariadne Labs, a joint center of Brigham and Women’s Hospital and the Harvard T.H. Chan School of Public Health. Scientists at Ariadne Labs helped develop and adapt the checklist and, with Population Services International, are leading the largest randomized controlled trial – called the BetterBirth Program –to test its effectiveness at lowering maternal and neonatal deaths. The BetterBirth Program is implementing the checklist with peer-to-peer coaching and data feedback in more than 100,000 live births across Uttar Pradesh, India.
In this Q&A, Dr. Katherine Semrau, a Brigham epidemiologist in the Division of Global Health Equity and the Director of the Ariadne Labs BetterBirth Program, tells us more about the Safe Childbirth Checklist.
How are we doing, globally speaking, when it comes to maternal and neonatal care in childbirth?
Since the establishment of the Millennium Development Goals in 2000, we have made great strides globally in reducing maternal mortality by 43 percent. Unfortunately, reductions in newborn mortality have been marginal; 45 percent of all child mortality occurs in the first 28 days of life. Even with these successes, 303,000 women and 2.9 million newborns die each year. We can do better.
Every year since 2005, BWH’s Division of Global Health Equity (DGHE) has offered an Introduction to Social Medicine course—jokingly referred to as “GHE boot camp” due to the jam-packed and demanding schedule of activities—in Rwanda or Haiti. The course is a way to introduce new global health equity residents to “global health: the Brigham and Partners In Health (PIH) way,” says BWH hospitalist and course instructor Dan Palazuelos, MD, MPH.
“We discuss many different themes in global health and are able to demonstrate our approach in real time, including how we partner with local governments and communities to achieve high-value clinical outcomes,” said Palazuelos, who is assistant director of BWH’s Hiatt Global Health Equity Residency. “The program is in part a product of the Brigham philosophy of how we treat each other, how we treat patients and why we pursue excellence in training. Like at the Brigham, all PIH sites are dedicated to doing whatever it takes to help patients get healthy again.”
This year, the course was held in Chiapas, Mexico, for the first time. The setting was a familiar one for Palazuelos, who, although having Mexican roots, first stepped foot on Chiapanecan soil in October 2005 as a Hiatt Global Health Equity resident. He originally set out to help with relief efforts after Hurricane Stan devastated the area, but he stayed dedicated to the region and ultimately worked with PIH to launch an entirely new comprehensive primary health care program there. Continue reading “DGHE’s Introduction to Social Medicine Course: Brigham at Its Best”→
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 “Addressing Inequities in Pregnancy Care and Childbirth in Chiapas, Mexico”→
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.