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How A Checklist Can Help Address Causes of Mother, Infant Death in Childbirth

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After years of testing in dozens of countries around the world, the Safe Childbirth Checklist was recently released by the World Health Organization (WHO) in collaboration with Ariadne Labs, a joint center of Brigham and Women’s Hospital and the Harvard T.H. Chan School of Public Health. Scientists at Ariadne Labs helped develop and adapt the checklist and, with Population Services International, are leading the largest randomized controlled trial – called the BetterBirth Program –to test its effectiveness at lowering maternal and neonatal deaths. The BetterBirth Program is implementing the checklist with peer-to-peer coaching and data feedback in more than 100,000 live births across Uttar Pradesh, India.

In this Q&A,  Dr. Katherine Semrau, a Brigham epidemiologist in the Division of Global Health Equity and the Director of the Ariadne Labs BetterBirth Program, tells us more about the Safe Childbirth Checklist.

Katherine Semrau, PhD, MPH
Katherine Semrau, PhD, MPH

How are we doing, globally speaking, when it comes to maternal and neonatal care in childbirth?

Since the establishment of the Millennium Development Goals in 2000, we have made great strides globally in reducing maternal mortality by 43 percent. Unfortunately, reductions in newborn mortality have been marginal; 45 percent of all child mortality occurs in the first 28 days of life. Even with these successes, 303,000 women and 2.9 million newborns die each year. We can do better.

Much of the focus on reducing maternal and newborn mortality has been on improving access to facility-based delivery with a skilled birth attendant in low- and middle-income countries. This approach has improved access to care—but that alone has not solved the problem. Continue reading “How A Checklist Can Help Address Causes of Mother, Infant Death in Childbirth” →

DGHE’s Introduction to Social Medicine Course: Brigham at Its Best

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SOLEDAD, CHIAPAS, MEXICO - AUGUST 13, 2015: Dr. Dan Palazuelos, center, talks to bootcamp participants in the community of Soledad. (Photo by Cecille Joan Avila / Partners In Health)
SOLEDAD, CHIAPAS, MEXICO: Dr. Dan Palazuelos, center, talks to bootcamp participants in the community of Soledad. (Photo by Cecille Joan Avila / Partners In Health)

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. Continue reading “DGHE’s Introduction to Social Medicine Course: Brigham at Its Best” →

The Poorest Billion

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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

Addressing Inequities in Pregnancy Care and Childbirth in Chiapas, Mexico

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Andrea and Rose Jalte
Rose Molina, BWH Connors Center Global Women’s Health Fellow, and Andrea Reyes, Maternal Health Coordinator at Compañeros en Salud

By Rose Molina, MD
BWH Connors Center Global Women’s Health Fellow

The motto of every pregnancy sounds simple: “healthy mom, healthy baby.” Yet, pregnancy and childbirth remain important causes of morbidity and mortality for reproductive-age women in resource-limited settings.

While the conversation about increasing Cesarean delivery rates and “medicalization” of childbirth in the United States continues, the reality in Chiapas, Mexico, is strikingly similar yet a world apart; both under-intervention and over-intervention exist, creating significant inequities in obstetric care. In Chiapas, the lack of access to quality services remains common for marginalized women, and “medicalization” can lead to “obstetric violence,” a term used to describe disrespect and abuse during childbirth. Continue reading “Addressing Inequities in Pregnancy Care and Childbirth in Chiapas, Mexico” →

Recent Studies Demonstrate Ways to Improve Quality of Care and Reduce Costs

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Thomas Gaziano

With a theme of “Noncommunicable Diseases: The Growing Burden,” the latest issue of Health Affairs features two studies co-led by BWH’s Thomas Gaziano, MD, of the Cardiovascular Division, and a team of authors.

The first study finds that cardiovascular disease screening by community health workers can be cost-effective in low resource countries. Understanding that a physician is not always available in low-resource settings, the authors demonstrated that community health workers can efficiently screen adults for cardiovascular disease in South Africa, Mexico and Guatemala. By using a paper-based or mobile phone-based screening tool that does not require blood testing, community health workers could conduct screenings in a cost-effective, or even cost-saving, manner in all three countries, compared to the usual clinic-based screening. “Our modeling indicated that screening by community health workers, combined with improved treatment rates, would increase the number of deaths averted from 15,000 to 110,000, compared to standard care,” write the authors.

The second study investigates the health and economic impacts of increasing prescription length for statins in South Africa, where the rates of statin use are among the lowest in the world.   “Almost five percent of the country’s total mortality has been attributed to high cholesterol levels, fueled in part by low levels of statin adherence,” write the authors.

They found that increasing prescription length from the standard 30 days to 60 or 90 days could save 1,694 or 2,553 lives per million adults, respectively. In addition, annual per patient costs related to cardiovascular disease would decrease by $152.41 and $210.29, respectively. “Increasing statin prescription length would both save resources and improve health outcomes in South Africa,” conclude the authors.

Maru’s Efforts in Nepal Highlighted by NIH

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Duncan_Maru2
Duncan Maru

Dr. Francis Collins, director of the National Institutes of Health, recently wrote a blog post highlighting Duncan Maru, MD, PhD, of the BWH Division of Global Health Equity, and his work in Nepal. In 2008, Maru co-founded Possible, a non-governmental organization that manages the health care system of Accham (a rural district of Nepal) through a public-private partnership with Nepal’s Ministry of Health and Population.

Maru has dedicated his career to developing innovative ways of delivering high-quality, low-cost care in developing areas of the world. He hopes that the work he is doing in Accham with Possible will ultimately help create a model to revitalize health care systems in Nepal and under-resourced settings around the world.

Read the blog post, “Creative Minds: Lessons from Halfway Around the Globe,” here.

BWH Employee Organizes Aid for Dominica

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Petite-Savanne-evacuees (2)On Aug. 27, the tiny nation of Dominica was devastated by a tropical storm that dropped more than 15 inches of rain on the island. Landslides and massive flooding ensued, killing more than 30 people and leaving hundreds homeless.

“This is a significant blow to any island, particularly one with about 70,000 people,” says Shirma Pierre, administrative director for BWH’s Center for Community Health and Health Equity. “The infrastructure has been crippled, and it is estimated that the storm has set Dominica’s development back 20 years.”

Pierre, who was born in Dominica and grew up there, is responding to the call for assistance along with other members of the Dominican community in Boston. The relief effort, “Boston for Dominica,” will provide assistance towards high priority needs of people in Dominica affected by the storm. The group is working with the government of Dominica to facilitate the collection and distribution of items that are deemed priority. Continue reading “BWH Employee Organizes Aid for Dominica” →

Improving Access to Healthcare in Nepal

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Since 2008, Possible (formerly known as Nyaya Health) has been committed to delivering high-quality, low-cost healthcare to the people of Nepal. The non-governmental organization was founded by a group that includes Duncan Maru, MD, PhD, and brothers Ryan Schwarz, MD, MBA, and Dan Schwarz, MD, MPH, who are former or current residents with the Doris and Howard Hiatt Residency in Global Health Equity and Internal Medicine for Brigham and Women’s Family Care Associates at Brigham and Women’s Faulkner Hospital.

Cracked walls of the Bhirkot Health Post that was damaged during the earthquake and will be one of the health posts rebuilt by Possible in 2015.
Cracked walls of the Bhirkot Health Post that was damaged during the earthquake and
will be one of the health posts rebuilt by Possible in 2015.

Nepal is one of the world’s poorest countries, but it also has some of the most progressive healthcare policies. The country’s constitution guarantees the right to health and universal healthcare for the poor. However, in rural areas, millions don’t get the care they need from the traditional private, public and philanthropic approaches to healthcare. That’s where Possible and its durable approach to healthcare come into play. Durable healthcare is a public–private partnership that enables a nonprofit healthcare company to be paid by the government to deliver healthcare within the government’s infrastructure.  It brings together the quality of the private sector, access of the public sector and innovation enabled by philanthropy. Core financing is tied to performance. Read the full story.

BWH Nurse Mentors Partner with Haitian Nurses to Improve Care

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A group of dedicated BWH nurses are helping to make a lasting impact on patient care, nursing education and scholarship in Haiti through a unique mentorship program.

Every summer for the past five years, the BWH Nursing department has hosted cohorts of nurses from Haiti for four days, pairing them with BWH nurses on patient care floors, who serve as mentors. This initiative is part of the International Nurse Faculty Partnership called the Regis College Haiti Project, a collaboration between the Regis College School of Nursing, Science and Health Professions, Partners In Health (PIH), Haiti’s Ministry of Health, and Haiti’s State University that strives to improve access to quality health care in Haiti by addressing the acute nursing shortage and the call for advancement of nursing education.

Nurses from Haiti visit BWH
In June, BWH welcomed Haitian nurse educators to CWN 9 for four days of clinical shadowing and discussion.

The rigorous education and leadership program is offered to Haitian nursing faculty across Haiti, who enroll in the master’s of Nursing program at Regis and spend time in clinical settings as part of their learning experience. “Spending time in a clinical setting is absolutely essential to learning,” said Patrice Nicholas, DNSc, DHL (Hon.), MPH, MS, RN, ANP, FAAN, director of Global Health in the BWH Center for Nursing Excellence.

Continue reading “BWH Nurse Mentors Partner with Haitian Nurses to Improve Care” →

Community Trust and the Ebola Endgame

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What must be done in order to end the Ebola epidemic?

BWH’s Ranu Dhillon, MD, and J. Daniel Kelly, MD, of the Wellbody Alliance, co-authored a perspective piece in the New England Journal of Medicine to propose some answers to this pressing question, focusing specifically on Guinea.

The doctors outline the importance of gaining trust and enhancing community respect for response efforts as Ebola teams engage with communities and try to end the epidemic. In the article, they explain how community distrust, rooted in recent decades of misrule and political tumult, enables Ebola to persist. They write:

“In Guinea, community distrust enables Ebola to persist in areas where people continue to hide the sick, conduct funerals in secret, and elude contact tracing…We need to build trust with communities and enhance their respect for response efforts if we are to overcome these challenges and bring the epidemic to an end. Communities are not uncooperative because they are backward or uneducated. On the contrary, they harbor a distrust of Ebola response efforts that is completely rational, given their experience during recent decades of misrule and political tumult…”

Read the full perspective, called “Community Trust and the Ebola Endgame,” in the New England Journal of Medicine.

Ranu Dhillon, MD, is a member of the BWH Division of Global Health Equity and an advisor to the president of Guinea on the Ebola response. J. Daniel Kelly, MD, is the co-founder of Wellbody Alliance, which works alongside Partners In Health in Sierra Leone.