November 21, 2014

Foreign Affairs in Ethiopia and U.S. – Different yet Similar

Mekonnen Haddis, Chief Advisor of the Minister, Ethiopia 
As I sat and listened to U.S. public servants discuss problems they have faced regarding employee retention and recruitment for the government, I was surprised, yet somehow comforted to realize that Ethiopia and the U.S. face similar challenges. 
Our Ethiopian delegation was so pleased to be invited to Yale University by the Global Health Leadership Institute for the Strategic Thinking in Foreign Affairs Symposium. During our visit, my Ministry of Foreign Affairs colleagues and I heard from leading practitioners and U.S. public servants who were candid in sharing their views and knowledge with us on a range of issues. Their insight helped us to develop better strategic plans on our own foreign policy, organizational capacity and leadership, which will prove invaluable when we return home.
During our week on the Yale campus, some of the work I most appreciated involved our Yale colleagues sitting down with us to solve problems we had identified within our government system. Through discussion and exercises with some of United States’ leading grand strategy thinkers, we learned to put theory and practice together to address critical problems.
We left New Haven to spend a week in Washington, D.C., visiting the State Department and government representatives. What impressed us most in DC was the priority that the U.S. officials gave us, ensuring they spent time with us in spite of their work load to help us in our endeavors to transform our ministry and country. The level of respect we received at the Department of State and all other places was exceptional. As this was the first visit to D.C for many of us, we were also anxious to see the landmarks about which we had heard so much. The Foreign Service Institute was much bigger than we had expected, and The White House, Capitol and Lincoln Memorial visits were unforgettable. 

After our impressive visit to the U.S., we confidently take home guidance and experiences to embark on a strategic mission to implement our foreign policy both with vigor and commitment.

November 17, 2014

A Closer Look at Cardiac Care

Heather Fosburgh and Dayna Keene, YSPH Professor
Heather Fosburgh, GHLI Program Manager

It’s still hard to believe that in the course of seven weeks, the GHLI Leadership Saves Lives team has travelled to ten hospitals in ten different states to conduct more than 150 interviews to learn more about the cardiac care process in each of the hospitals.

I had the opportunity to participate in interviews and observations at three hospitals in Arizona, Illinois and Florida. Each hospital, like its geographic location, was unique … as were the people. However, interwoven in these differences, were common threads of excitement and eagerness to find new ways to improve patient care. Whether it was a nurse, a physician or an information technology specialist, hospital staff and faculty were truly interested in how they could help make a difference. It was inspiring to see their passion and motivation. 

Conducting these interviews for the LSL program provided me a brief but up-close glimpse into how things are behind the scenes of hospital patient care and management. We spoke with more than a dozen staff members at each hospital who shared, stories, experiences, and honest feelings with us.   

We have six months before the next round of hospital site visits start and during that time, we will be busy reading and analyzing the information collected to date. I find it fascinating to know that taking these individual experiences and combining them all together will contribute to a body of research that strives to understand what aspects of organizational culture can help improve mortality rates for patients with heart attacks.

Although it was less than two months work for me, I remain impressed by how much coordination it takes to effectively care for a patient who suffers from a heart attack coupled with the dedication of the people who provide this care.

November 5, 2014

Using My Words – In Amharic

Elizabeth Bradley, Ph.D., Faculty Director, GHLI

Kebahd! Thanks to some brief tutoring in Amharic I was now able to communicate more fluently on my recent trip to Ethiopia. Most of my new words, and the language itself, are lyrical – “silematachu des bolognal” and “bet’am tiru enimesagenalen” – syllables tumbling out with the sound of a bubbling brook. I had been using these phrases to say “I am happy to be with you” and “thank you for being here” to the delight of my Ethiopian colleagues who seemed tickled that I finally could say more than “excuse me” and “thank you.”  

My Amharic words also helped my sureness, as I could detect meaning in what previously had been a jumble of foreign sounds. This ability was invaluable when we met with the director of the CDC in the US Embassy and received a personal briefing on Ebola - and during my visit to Black Lion Hospital, where I saw where people suspected of having Ebola were to be placed until they could be transferred to a clinic or hospital for treatment. Later, my visit to the US Embassy where the transport system and Ethiopian policies were described went smoothly, and I felt comfortable.  

I thought about how much I loved Ethiopia with all its pleasure and beauty. And I was heartened to see and get a better grasp of how honest the work is to keep the country moving ahead to improve not only health care, but all social services for its citizens.  While I still see young mothers struggling and small children put to work instead of being in school, I know with the dedication being shown by the government this will be less and less. But still "Kebahd" – difficult.

As I experienced both aspects of this country on this visit – the tremendous strides and evolution they have made since my first visit eight years ago – and the inequity that still exists here as well as around the world – I realize that even knowing the language doesn't make it any easier to understand sometimes.  

October 9, 2014

Clean Hands in Rwanda

April Budd, GHLI Health Management & Leadership Mentor

In 2013, Muhima Hospital started on its journey to improve hand hygiene for its patients, staff and visitors. For years, the hospital struggled to provide proper hand sanitizing resources to employees and patients. At times, a department would have soap but a non-functioning sink, or the sink would be working and soap was absent. In cases where both were present, there was the issue of no paper towels to properly dry hands. This occurrence led to staff members who diligently wash their hands having to use their own, often soiled, clothing to dry hands, therefore re-contaminating recently cleaned hands. 

After hand hygiene was acknowledged as a deficiency at the Hospital, the Human Resources for Health Program (HRH) management and leadership team joined Muhima to work on pertinent quality improvement needs. The HRH managers from Centre Hospitalier Universitaire de Kigali (CHUK) suggested implementing hand sanitizer production locally. In January 2014, specifically trained staff produced the first batch of sanitizer at Muhima Hospital using a formula from the World Health Organization. Over the next six months, a Hand Hygiene Initiative team managed a gradual roll out to implement the hand sanitizer project across the hospital including sensitization sessions and demonstrations to teach physicians, nurses and staff on the most effective sanitizer use methods.  

Currently, hand sanitizer is available for patients, staff and visitors in all inpatient departments at Muhima Hospital and hopefully will be in outpatient areas this month. The team most recently celebrated acceptance to the Infection Control Africa Network conference to be held in Harare Zimbabwe this year at which they will present on lessons learned from the process. This project has largely been successful, not only due to a having a great team pushing it out to users, but mostly due to the staff buy-in. The staff are demanding the hand sanitizer through utilization and ordering and due to a good planning team, the hospital is prepared to meet the need.

August 28, 2014

U.S. Counties Winning the War on Obesity

Patrick Ng, 2014 GHLI Fellow

This summer I had the exceptional opportunity to help investigate the obesity epidemic in the U.S. I traveled with GHLI researchers across the country to five counties that, in spite of their socioeconomic profiles, which were associated with higher rates of obesity, were faring astonishingly well with rates among the lowest in the country. We termed these counties “positive deviants” – or counties that were statistical role models – and hypothesized that the strategies by which these counties marketed, integrated, and sustained programs for healthy living were making the difference.

Our team gathered data by interviewing local community leaders to pinpoint factors that would foster an environment conducive to healthy living. Though each location was unique –some characterized by arid deserts and others by lush hills–we could not help but notice striking similarities across the counties. 

We observed the importance of having open-minded, persistent, and empowering leaders in the fight against obesity – from school nurses to master gardeners to non-profit organizers – who worked tenaciously to see their families and friends thrive. These champions set an example for their colleagues who also responded with self-drive.

Community pride ran deep: both young and old showed their dedication through strong involvement in volunteering and through honest dialogue. Many of these counties showed exceptional openness to modern standards for “healthy living,” some times even at odds with local traditions. This cultural resilience and flexibility seems to have made these counties particularly nimble in combatting obesity – a very social disease. 

Our interviews have suggested that a proactive, supportive environment is needed to transform awareness about obesity into action and, ultimately, long-term change.

August 25, 2014

Making Babies Breathing Affordable

Charles Stone, ‘ 14, GHLI Intern

Each year, an estimated three million babies die during the first four weeks of life around the world. More than 50% of these deaths are attributed to birth asphyxia, respiratory insufficiency and complications stemming from preterm birth.  Devices to help prevent some of these deaths – such as the Humidified High Flow Nasal Cannula (HHFNC), which costs $5,000, are prohibitively expensive for low resource settings.

As interns at the Yale Global Health Leadership Institute, undergraduate engineers Katy Chan '15, Jordan Sabin '16 and myself (Team PremieBreathe), made encouraging strides to address this issue. Building on a design I developed for my senior project, our goal was to fabricate a functional, low-cost prototype of the HHNFNC. 

Every day presented new challenges as we grappled with tricky physics concepts. We spent hours theorizing and testing (and re-testing) how best to control the vapor pressure of traveling air at varying temperatures.   Perhaps the most insightful part of the project involved understanding how our prototype would behave when in contact with a baby.  For this we had to be quite creative.  We rolled up heating pads to resemble the size of a premature infant and “dressed” the bundle in Jordan's finest set of baby clothes.  From this we learned that this thermal contact with the nasal cannula significantly reduced condensation in the system. We celebrated that small milestone over tasty hamburgers at Louis' Lunch (home of the original hamburger!). 

By the end of this summer, we demonstrated that our prototype closely mimicked the commercial device -- for the modest price of $340. It delivers a customizable flow of humidified and warmed air, through a standardized nasal cannula that feeds into a baby’s nostrils.

We are excited to continue project with the ultimate of goal of visiting Ethiopia to better adapt the device for use in the developing country context.