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The Poorest Billion

The poorest billion people in the world do not have access to quality health care, including preventive services, says Paul Farmer, MD, PhD, BWH’s chief of the Division of Global Health Equity. ]

In this video,  Farmer announces a new Clinton Global Initiative commitment by Partners In Health and The Lancet to address non-communicable diseases among the poorest billion.

Video via the Clinton Global Initiative

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Paul Farmer Appears on “The Colbert Report”

“There is a lot of evidence that would suggest the world will be a safer and more prosperous place if there are not these kind of inequalities, if we address them.”

Dr. Paul Farmer, chief of BWH’s Division of Global Health Equity and co-founder of Partners In Health, received resounding applause from the audience of “The Colbert Report” after making this statement during his guest appearance on the show Dec. 4.

Farmer discussed the reasons why he has dedicated his career and life to serving the poor and the incredible work of Partners In Health in helping tens of millions of people across the globe.

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Partners In Health Receives UNITAID Grant to Revolutionize Access to MDR-TB Treatment

This week, Partners In Health announced a new partnership with UNITAIDDoctors Without Borders/ Médecins Sans Frontières (MSF), and IRD to revolutionize access to new multidrug-resistant tuberculosis (MDR-TB) treatment in 17 countries, especially among the poor.

“We’re grateful for this support from UNITAID, and particularly for their partnership, with which we’re hoping to make diagnosis and treatment of drug-resistant tuberculosis more effective and more tolerable for patients, as well as more readily accessible and lower-cost,” says Paul Farmer, MD, PhD, co-founder of Partners In Health and chief of BWH’s Division of Global Health Equity. “UNITAID has given us a way to use the power of markets to serve the poor, driving down the cost of essential commodities and helping to deliver them to the people who need them most.”

Read more about the UNITAID grant that will make this work possible.

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Global Health Summit Offers Insight, Inspiration

BRIGHAM AND WOMEN'S HOSPITAL AND HARVARD MEDICAL SCHOOL HOST THE GLOBAL HEALTH SUMMIT MONDAY AFTERNOON
From left, Paul Farmer, Atul Gawande and Nawal Nour share a laugh during the keynote panel at the Global Health Summit.

Through the stories and insights shared during the Nov. 25 Global Health Summit, attendees were transported to war-torn Somalia, the mountains of Rwanda and back home again.

Throughout the afternoon, they heard Andrew Ellner, MD, MSc, of BWH’s Division of Global Health Equity, demonstrate the need for an overhaul of the American health care system and Michael VanRooyen, MD, MPH, FACEP, of BWH’s Department of Emergency Medicine, share his personal insights into training the next generation of humanitarian workers.

Attendees listened intently as BWH associate physician Ashish Jha, MD, MPH, asked the poignant question about preventable health care costs: “How is it safe to fly a 30-year-old plane but not use a 6-year-old CT scanner?”

Hosted by BWH, Harvard Medical School (HMS) and Harvard School of Public Health (HSPH), the Global Health Summit—a BluePrint-themed event—provided a thought-provoking inside look at the important work being done in the global health arena. Special guests and BWH, HMS and HSPH leaders and staff came together in the Joseph B. Martin Conference Center at HMS to learn lessons straight from the field from expert physicians, patients and donors in three panels.

“What makes global health work successful is partnership,” said BWH President Betsy Nabel, MD, who provided an introduction and closing for the event’s last panel. “The ability to connect and work together is essential.”

Robert Riviello, MD, MPH, and Daniel Ponton discuss stories from the field in Rwanda.
Robert Riviello, MD, MPH, and Daniel Ponton discuss stories from the field in Rwanda.

In one panel, BWH surgeon Robert Riviello, MD, MPH, of the Division of Trauma, Burns and Surgical Critical Care, shared his inspiration for getting involved in global health work: his Christian faith and growing up reading stories of saints and missionaries.

“That dedication, resilience and effectiveness struck me as, ‘This is ‘good with a capital G’ work – work you would want to spend your life doing,’” he said.

Joining Riviello on the panel was philanthropist and former BWH patient Dan Ponton, who spoke about his partnership with Riviello to build much-needed housing for doctors in Rwanda. Ponton, who was successfully treated at BWH for a life-threatening brain tumor, saw how the housing shortage made it difficult to attract and retain qualified medical staff. His foundation—the Daniel E. Ponton Fund at Brigham and Women’s Hospital—subsequently funded and built the Butaro Doctors’ Housing project.

During the panel, Ponton shared the inspiring message that “it doesn’t always take a doctor to solve a health care problem.”

In the event’s final panel, WBUR “Here & Now” co-host Robin Young spoke with global health luminaries Paul Farmer, MD, PhD, Atul Gawande, MD, MPH, and Nawal Nour, MD, MPH, in what resembled a personal living room conversation among friends.

After providing introductions of each other, the three panelists answered Young’s thoughtful questions, sharing everything from their inspirations to formative moments in their lives and careers—including Farmer’s admission that working in Haiti was his “Plan B.” Plan A was working in West Africa.

Gawande, a self-described “professional dilettante,” or dabbler, said that he has always been interested in change and why it seems so hard. He sees his research and writing as ways to “work through the puzzles and try to solve problems.”

He later summed up the spirit of BWH by saying: “If you’re not leading by making a difference, then you’re not fulfilling the mission of this place.”

Nour discussed her work with the African Women’s Health Center at BWH, which she founded in 1999, and the nuances and complexities of the beliefs held by her patients, many of whom have experienced female genital cutting.

Of the media’s flashing interest and coverage of women’s and children’s health issues, Nour said: “If we could sustain that interest and funding, we could make changes systematically. If more people looked at health issues through a gender-based lens, we could make great improvements.”

View a photo gallery from the event.

Watch webcasts of the panel discussions:
“The Global Health Experience: What We Can Learn”
Introduction and moderation: Jeffrey Flier, MD
Panelists: Andrew Ellner, MD, MSc, Ashish K. Jha, MD, MPH, Michael VanRooyen, MD, MPH, FACEP

“Making Global Health Happen”
Introduction and moderation: Julio Frenk, MD, PhD, MPH
Panelists: J. Christopher Flowers, Dyann Wirth, PhD, Daniel E. Ponton, Robert Riviello, MD, MPH

“To Alleviate Human Suffering: Our Work to Strengthen Global Healthcare”
Introduction: Elizabeth G. Nabel, MD
Moderation: Robin Young
Panelists: Paul Farmer, MD, PhD, Atul Gawande, MD, MPH, Nawal Nour, MD, MPH
Closing: Elizabeth G. Nabel, MD

 

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A Guide for Global Health Workers

building partnerships in the americasThe recently published book, “Building Partnerships in the Americas: A Guide for Global Health Workers,” is an important resource for those working in global health.

According to BWH Chief of Global Health Equity Paul Farmer, MD, PhD: “This book answers a great, and until now unmet, need. For all those who ask what to read before going to work in these settings, ‘Building Partnerships in the Americas’ is the answer. It’s sure to become the go-to volume for those deeply engaged in such work.”

BWH’s Dan Palazuelos, MD, MPH, of the Division of Global Health Equity, is a co-author of the book’s first chapter about Mexico. You can learn more about the global health experiences of Dr. Palazuelos and his fellow authors  during “An Evening with the Authors” on Sept. 7, 7:30 – 9 p.m., at the AIC Center, 38 Newbury St., seventh floor, Boston.

The event is free and open to the public. Refreshments will be served. Please register in advance.

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The Equity Imperative

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“There is no correlation between money and what you can offer your people,” said Rwandan Minister of Health Agnes Binagwaho. “Money is not the obstacle; your vision is the obstacle.”

Paul Farmer, MD, PhD, Chief of the Division of Global Health Equity at BWH, introduced Binagwaho to the audience gathered on July 23 at Harvard School of Public Health. Binagwaho was a guest speaker at Harvard’s Global Health Effectiveness Program, which is co-directed by Joseph Rhatigan, MD and Rebecca Weintraub, MD, both Associate Physicians in BWH’s Division of Global Health Equity.

Over the next two hours, Binagwaho shared how reforms in Rwanda’s health care sector had produced stunning results: Despite a GDP of less than $1000 per capita, life expectancy in Rwanda has doubled since 2004. Continue reading “The Equity Imperative”

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"Every Rwandan Ought to Be Proud"

Paul Farmer, in a photo taken by The New Times during a recent interview.
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Paul Farmer, MD, PhD, chief of BWH's Division of Global Health Equity and Partners In Health co-founder, recently told “The New Times” that Rwanda is on track with its work addressing disparities in health care.

He spoke of the progress the country has made so far in health care provision: “There is remarkable progress made, especially if you look at fertility rates, mortality rates or life expectancy. If you look at only six indicators such as death due to Aids, malaria, tuberculosis and during child birth and from vaccine preventable illnesses and under five, significant progress has been made. Rwanda is the only country in sub-Saharan Africa on track to meet all the health-related Millennium Development Goals.

If you look at those six indicators, you see that Rwanda has the steepest decline in mortality ever documented anywhere at any time, so that means even more than Europe after the war. It’s very striking. Every Rwandan ought to be proud of that.”

Read the full interview in “The New Times,” a daily newspaper in Rwanda.

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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.