This week, the BWH-led Team Heart is embarking upon its eighth annual mission to Rwanda to perform life-saving heart surgery for patients with rheumatic heart disease. The team performs one out of every four cardiac surgeries in Rwanda.
Chip Bolman, MD, a cardiac surgeon at BWH, founded the team with his wife, Ceeya Patton Bolman, MSN, RN, in 2008. Read all about the team’s work in this Boston Globe article, and visit Team Heart’s website for more information.
One of BWH’s global health experts, Robert Riviello, MD, MPH, is training for the Boston Marathon while he is in Rwanda this month. This year’s marathon is especially meaningful to Riviello, as he was working in BWH’s Emergency Department when the bombs exploded at last year’s marathon.
Soon afterward, I received an email from a physician I work with on my regular travels to Rwanda that simply said, “Be strong.” This doctor, a survivor of genocide who I have teamed with as a part of BWH’s Center for Surgery and Public Health, was now supporting me in my community’s time of need.
It was a moving reminder that, no matter who you are or what your circumstances, you never know when you’ll need support—or when an encouraging word can mean the world to someone else.
That’s why I’m running in this year’s Boston Marathon—to pay tribute to the community who stood strong and supported each other through last year’s tragic events. And with less than three weeks until Marathon Monday, my teammates and I could all use some words of encouragement right about now.
I’m writing to you now from Rwanda, where I’m continuing my work with Dr. Georges Ntakiyiruta, but I’m still doing my marathon training—and it hasn’t been easy. (That’s me in the photo, training solo here.)
Running up Mount Kigali is always worth it for the great view, but to make it up there I have to motivate myself by remembering why I’m doing this: to honor the courage of our patients and the passion of our care teams.
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.”
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.”
In recognition of Dec. 1 as World AIDS Day, BWH physician Neil Gupta, MD, MPH, contributed a compelling op-ed piece to The Atlantic on HIV treatment in Rwanda. Gupta, the deputy clinical director for Partners In Health in Rwanda, has witnessed the success of Rwanda’s approach to HIV care and treatment, and the impact it has had on the lives of Rwandans.
He writes: “In Rwanda, where just 20 years ago a genocide claimed approximately 1 million lives, the government has transformed HIV care for the poor by redefining the standards for successful treatment. More than three decades into the epidemic, many national and international agencies are still counting the basics—how many people get infected, how many people receive medication, how many patients die. Success in Rwanda, meanwhile, is measured not in the number remaining alive, but rather in how many are actually able to take their medications as directed and suppress the virus in their bodies to a level where it is essentially non-existent. In Rwanda, success is achieved when people living with HIV can earn a living, support their family, raise their children, and care for their community no differently than their peers.”
Six years ago, a young man in his 20s lay dying in a hospital bed in Rwanda. Emaciated, bed-ridden and incredibly ill with bacterial endocarditis, Jean Paul Iyamuremye’s chances of survival seemed slim. It was a drastic change from just four months earlier, when life had been so promising. He had just married a wonderful woman named Jacky, and they were ready to start their lives together.
But Jean Paul was lucky. While he was in the hospital, a newly formed group, called Team Heart, was just beginning to plan its first cardiac surgery mission to Rwanda. Led by BWH cardiac surgeon Chip Bolman, MD, and his wife, Ceeya Patton Bolman, RN, the team met Jean Paul and planned to operate on him during their mission five months later, hoping that he would survive in the interim.
He did, and received the first mechanical valve to be done in Rwanda on Team Heart’s inaugural trip in April of 2008.
Today, a vibrant, healthy and optimistic Jean Paul has just returned from Hawaii, where he received an award for his advocacy work on behalf of other Team Heart patients. The team returns to Rwanda each year, and Jean Paul is committed to helping patients as they undergo surgery and begin to recover. Continue reading “Team Heart Patient Receives Award for Helping Others”→
When you only have two pathology laboratories in a country of 10 million people, clinicians often have to make treatment decisions without pathology results. This was the case in Rwanda, until BWH joined with other organizations to reduce turn-around times and ultimately build capacity in the country’s pathology labs.
“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”→
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.”
Learn more about the work of Team Heart in this new documentary, “Hearts of Courage.” The team is led by BWH Chief of Cardiac Surgery Chip Bolman, MD, and his wife, Ceeya Patton Bolman, MSN, RN. Each year, many BWHers volunteer their time and skills to provide life-saving surgery and care to Rwandans suffering from rheumatic heart disease.
The impact of the Human Resources for Health (HRH) program on Rwanda isn’t simply improving health in the African country. It’s changing everything.
“This program is a way that we can reverse the injustice of poverty,” said Dr. Agnes Binagwaho, minister of Health in Rwanda, of HRH’s long-term impact.
The seven-year HRH program is a partnership between the Rwandan government and universities and hospitals in the U.S. that strives to achieve one goal: to help Rwanda develop a high-quality and sustainable health care system. The program enables Rwanda to train and educate its health care workforce, care for the country’s patients and, as an indirect result, bring new businesses to the country that will stimulate economic growth.
During her visit to BWH last week, Binagwaho presented with BWH President Betsy Nabel, MD, about Rwanda’s health care needs and HRH’s first year of progress to a packed Bornstein Amphitheater. Binagwaho likened her country’s challenge in developing its own health care workforce to a classic “chicken and egg” conundrum.
“How can we produce these professions we need when we don’t have the people to train them?” she asked. “So we thought about creating partnerships with universities and hospitals like the Brigham. Let’s borrow ‘chickens’ from the United States to produce ‘eggs’ for Rwanda. This is a way to bring more justice by improving access to care.”
HRH launched last fall, with 97 faculty members—nine of whom are BWH physicians—participating from 23 universities in the U.S., including Harvard Medical School. The faculty members are focused on educating and training the next generation of doctors, nurses, midwives and other health care professionals.
When the program concludes in 2019, Rwanda’s workforce should be sustainable without foreign aid. In its first year, HRH is focusing on educating professionals in five specialties: gynecology, internal medicine, surgery, pediatrics and anesthesiology. After two years, the program will begin to focus on building subspecialties, such as pediatric surgery.
The needs in Rwanda are staggering. The country currently has six physicians per 100,000 people. By comparison, Boston alone boasts 1,053 physicians per 100,000 people. There isn’t a single cardiac surgeon, pathologist or cancer specialist in the country. HRH works to strengthen these and other specialty fields with critical shortages.
Led by co-investigators Robert Riviello, MD, and Corrado Cancedda, MD, HRH also builds upon the existing partnerships that many BWHers have already formed in Rwanda, including those through the Division of Global Health Equity, Partners In Health, the Center for Surgery and Public Health and the BWH-led Team Heart (see related story). While the HRH model builds on these programs and efforts, it also raises existing collaborations to an academic level to ensure Rwanda can educate the next generation of health care professionals and build a sustainable health care system.
“This is a wonderful partnership,” Nabel said. “I believe that reciprocity is the prize at the end of the day. We benefit from learning from one another and growing through this experience.”