Under the Same Sun: Helping Others Locally and Globally

Reposted from Brigham Clinical & Research News
By Abaraar Karan, MD, MPH
25 February 2019


Marshall Wolf (left) and Abraar Karan (right)

Next Generation is a Brigham Clinical & Research News (CRN) column penned by students, residents, fellows and postdocs. This column is written by Abraar Karan, MD, MPH, a second-year resident in the Department of Medicine and the Doris and Howard Hiatt Residency in Global Health Equity. He was recently named a 2018 40 Under 40 Healthcare Innovator by MedTech Boston, as well as a 2018 STAT News Wunderkind. If you are a Brigham trainee interested in contributing a column, please email bwhclinicalandresearchnews@partners.org.

Continue reading “Under the Same Sun: Helping Others Locally and Globally”

Ebola, A Year After the Epidemic Began

December marked one year since the first case of Ebola was found in Guinea, leading up to the deadliest Ebola epidemic in history.

Rajesh Panjabi, MD, MPH, of BWH’s Division of Global Health Equity and co-founder and CEO of Last Mile Health, recently returned from Liberia where he has been working with the government and other partners to respond. He spoke with WBUR’s “Here and Now” about the outbreak, the progress we have made and the new challenges we are facing in fighting the disease.

Panjabi told WBUR: “Ebola anywhere is a threat to people everywhere, and so you cannot have almost zero with Ebola. You’ve got to get to zero cases.”

Read more: http://hereandnow.wbur.org/2014/12/29/ebola-year-update

The Coming Transformation in Global Health

The 20th century witnessed a monumental transformation in hospitals: once primarily places for poor people to die, hospitals became institutions that cured illness and promoted health. A range of facilities and professionals dedicated to treating the sick grew in tandem with the proliferation of hospitals, creating the health care systems we have today.  

Health care systems are now pervasive enough that even developing countries have structures for delivering care. Advances in treating HIV, heart disease, and other chronic conditions mean that a significant part of the population now lives for years in less-than-perfect health.  As we grow increasingly reliant on this care, the question before us is how to strengthen health systems in order to deliver quality care to all who need it.

This was the pivotal theme at the talk “The coming transformation in global health,” held at Harvard Medical School on Feb. 28.  Moderated by Paul Farmer, MD, PhD, chief of the Division of Global Health Equity, the discussion was framed by Lord Nigel Crisp KCB, former head of the National Health Service in the United Kingdom, and Dean Julio Frenk, MD, MPH, PhD, former minister of health of Mexico and current dean of the Harvard School of Public Health.

Frenk discussed the challenges and opportunities he encountered while reworking the health care system in Mexico. We can create a platform for enlightened social change by carefully and conscientiously restructuring our health care systems, but Frenk felt it was vital that these reforms be evidence-based and involve explicit ethical deliberation.  When these systems change for the better, they can have a tremendous impact: 30 percent of children with leukemia in Mexico had to stop treatment because their families ran out of money, but this number dropped to two percent after the implementation of health care reforms.

Having worked extensively in both the UK and developing nations, Crisp was particularly struck by the lack of health workers in many resource-poor settings. One way around the exodus of trained medical professionals from their countries of origin is to break down the demarcations between health professions. Crisp cites settings in Africa where nurses have been trained to do Cesarean sections—patient outcomes are comparable to doctors performing the operation, with the added bonus that nurses are less likely to move abroad.

Another potential solution for limited availability of medical professionals is to engage patients in their own care, as well as with helping and supporting fellow patients. Even in settings with abundant staff and resources, such as a self-dialysis clinic in Sweden, this approach can energize and engage patients, lower infection rates, and increase patient satisfaction. Crisp emphasized that health is a co-production function: it is not something doctors give patients, but something that patients create with intermittent assistance from clinicians.

Throughout the program, the speakers underscored that health is not separable from other human endeavors. Just as the duty of hospitals shifted from comforting the dying to curing, the challenge going forward is to reform health care systems to deliver care not just to the privileged, but to all in need.