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.
“I simply fell in love with the area,” he said. He now leads the social medicine course with the division’s Joia Mukherjee, MD, MPH, and Joe Rhatigan, Global Health Equity Residency director—mentors who were themselves instrumental in helping to launch PIH-Mexico, locally known as Compañeros en Salud, says Palazuelos.
Participating in this course in Chiapas for 10 days were Global Health Equity residents Anne Beckett, MD, Bram Wispelwey, MD, and Peter Olds, MD, in addition to two fellows from Children’s Hospital, three fellows from the University of California, San Francisco, and a global health physician from Chicago. “These trainees are the future leaders of global health, so getting them all to share this experience and build lasting relationships with each other and on-site staff, who are themselves leaders, is incredibly powerful,” said Palazuelos.
Added Jennifer Goldsmith, MS, MEd, director of Administration for the division: “We often think of the impact of residency training in terms of long hours in the inpatient tower, but this alternative suggests that learning in the field at the start of a residency, and throughout, can create a framework for clinical innovation and understanding the context of care.” Goldsmith also attended this year’s course.
With a staff of 75 people, including Mexican clinicians, PIH staff and community health workers, the site provides the area with around 30,000 patient encounters a year, not including home visits, which number in the thousands. Building on the Mexican government’s commitment to provide comprehensive primary care, home visits help patients with everything from providing relief for a headache to starting the process to diagnose and treat lymphoma. Combining a variety of innovations in primary care delivery—including going to patients’ homes to diagnose chronic but potentially asymptomatic diseases like diabetes, or contracting and training community health workers to visit patients at home to help them make plans to take their medicines as prescribed—PIH-Mexico is achieving extraordinary results that exceed international rates. For example, rates of clinical control for hypertension exceed 80 percent, nearly 30 percent greater than in the U.S.
“This course is an extraordinary experiential learning opportunity; it is incredibly hands-on, and every moment the participants are soaking up lessons that will last a lifetime,” said Palazuelos. “Rural Mexico is very different from an inpatient service in Boston, but the thing that I love about global health is that there are lessons to be learned in both contexts that are relevant to each other. For example, we have to rely on a good physical exam in Mexico, but this is also very important in Boston. My physical exam skills were honed during my work in Mexico, but my Brigham patients also benefit.”
“I think that this is BWH at its best—a compassionate leader in teaching, patient care, research and community,” said Goldsmith.