From BWH Bulletin 8/26/16 by Jessica Zimmerman Traumatized by years of civil war and a devastating act of genocide in the early 1990s, Rwanda used to be a place where hope was in short supply.
Over time, however, the country came back stronger than ever—investing in education, infrastructure and regional trade—and Rwanda’s economy enjoyed one of the largest growth rates in the world last year. Still, one critical resource remained scarce: health care.
In 2010, the World Health Organization reported that Rwanda had one of the lowest rates of physicians per capita in the world. A country of nearly 11 million people, Rwanda was home to about 600 physicians at that time. Most were concentrated in large cities like Kigali, leaving rural areas underserved, especially in terms of specialists. Continue reading “BWH Continues as partner in building provider capacity and health equity in Rwanda”→
For BWH International Emergency Medicine fellow Nirma D. Bustamante, MD, having the opportunity to travel to Greece to care for refugees is an experience she will always cherish.
Front row, second from left: Nirma Bustamante with other volunteers at a refugee camp in northern Greece.
“I had the privilege of caring for, and most importantly, getting to know the most incredible human beings,” said Bustamante, of the Division International Emergency Medicine and Humanitarian Programs in the Department of Emergency Medicine at BWH, which prepares leaders in global health and humanitarian response.
Earlier this month, Bustamante spent more than two weeks at a refugee camp in northern Greece, along with volunteers from Team Rubicon, which recruits, trains and deploys U.S. military veterans and health professionals to aid in disaster-response operations around the world. Bustamante provided primary and urgent care to Syrian and Iraqi refugees, developed care plans and helped patients access specialty care in the local community.
Building capacity in specialty care is key to BWH partnership with Human Resources for Health Rwanda From BWH Bulletin 8/25/16 by Jessica Zimmerman
Training residents in anesthesiology is not only about teaching them the medicine behind the specialty, says Jill Lanahan, MD, of the BWH Department of Anesthesiology, Perioperative and Pain Medicine. It’s also about sharing a passion for the profession to inspire them to join the field.
Lanahan has done exactly that at the Brigham since March 2014, and for the next year she will share that same expertise and enthusiasm for anesthesiology with the next generation of physicians in Rwanda as part of the Human Resources for Health (HRH) Program, a collaborative, seven-year project between the Rwandan government, BWH, Harvard Medical School and more than 20 other academic institutions in the U.S. The program recently began its fifth year.
Lanahan—who relocated with her family to the Rwandan capital, Kigali, on Aug. 2—will spend one day each week doing didactic training with her new crop of residents. The other four days will consist of clinical training in the operating room. During her year-long position, she will offer three months of training in cardiac anesthesia, her primary area of clinical interest. Continue reading “BWH physician serves as anesthesiology faculty in Rwanda”→
Hanni Marie Stoklosa, MD, MPH’s background as a BWH emergency physician has inspired her work in addressing human trafficking. She founded an organization focused on combating human trafficking. Health Education Advocacy Linkage (HEAL) Trafficking (www.healtrafficking.org) focuses on addressing the health-related problems that trafficked victims face from a public health standpoint. In her role as researcher, advocate, and nationally and internationally recognized expert, she has years of experience in addressing this global problem. Dr. Stoklosa has done extensive research in all areas of trafficking including sex trafficking and labor trafficking. She is a leading force in addressing the myriad of health issues which are often overlooked by health professionals, as well as a force in advocating for human trafficking legislation before the US Congress. Dr. Stoklosa has advised the US Department of Health and Human Services and was recently named an American Board of Emergency Medicine fellow (2015-2017) of the National Academy of Medicine (formerly the Institute of Medicine). She holds appointments at Harvard Medical School, the Harvard T. H. Chan School of Public Health and the Harvard Humanitarian Initiative. She has extensive international experience in many countries. “I conducted qualitative interviews to further understand the anti-trafficking landscape and the gaps in response.” Her work has affected populations in India, Nepal, Thailand, and Kazakhstan, as well as Australia, China, Egypt, Guatemala, Liberia, the Philippines, South Sudan, and Taiwan. Most recently, Dr. Stoklosa has written a text (forthcoming, Springer Publishing in 2017) Human Trafficking Is a Public Health Issue: A Paradigm Expansion in the United States.Continue reading “Combating Human Trafficking: An Interview With Hanni Marie Stoklosa, MD, MPH”→
Kara Burge (center), a staff nurse in Orthopaedic Surgery, with two Operation Walk Boston patients
A year had passed since a young man came to the clinic with severe joint disease in his hips that left him unable to stand up straight, his torso pitched forward about 45 degrees as he steadied himself on a crutch.
But thanks in part to a group of volunteer clinicians from the Brigham, he was now running laps up and down a hallway at a hospital in the Dominican Republic, where he had received bilateral hip-joint replacement surgery through Operation Walk Boston—an orthopedic medical mission founded by Thomas S. Thornhill, MD, former chair of the BWH Department of Orthopaedic Surgery.
The program partners with Hospital General de la Plaza de la Salud in Santo Domingo to perform hip- and knee-joint replacements for patients who can’t afford the procedures. It completed its ninth mission in April. Continue reading “Operation Walk Boston Volunteers Go the Extra Mile”→
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.
Jon Einarsson (left) and James Greenberg (right) pose with a surgeon from Senegal.
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.
Brigham and Women’s Faulkner Hospital’s Chief of Gynecology James Greenberg, MD, and Director of the Division of Minimally Invasive Gynecologic Surgery at Brigham and Women’s Hospital and BWFH surgeon Jon Einarsson, MD, were among the group of physicians conducting the week-long course organized by Senegal native and Associate Obstetrician Gynecologist at BWH Khady Diouf, MD. Continue reading “BWH/BWFH Physicians Teach Minimally Invasive Techniques for Gynecological Surgery in Senegal”→
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.
MRCT Center staff include, from left, Heather Marino, program manager; Barbara Bierer, faculty co-director; Rebecca Li, executive director; Mark Barnes, faculty co-director; and Carmen Aldinger, program manager.
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.
Aaron Berkowitz teaches a neurology course to residents in Haiti.
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.”
Traumatized by years of civil war and a devastating act of genocide in the early 1990s, Rwanda used to be a place where hope was in short supply.
