Addressing NCDs in the Eastern Caribbean

Jamila Sykes,
Program Manager, GHLI

According to the World Bank, non-communicable diseases (NCDs) account for six of the top 10 leading causes of death in the Eastern Caribbean, quickly replacing infectious diseases as the main cause of mortality in the region. Communities in the Eastern Caribbean have devastatingly poor health outcomes for chronic conditions when compared with the U.S. mainland – making risk factors such as poor diet, physical inactivity and alcohol abuse major contributors to the death toll.

A delegation from the Eastern Caribbean, led by representatives from Trinidad and Tobago, will attend the GHLI Conference in June to focus on strengthening primary health care and to address the growing burden of NCDs in their region.

GHLI staff recently visited partners in Trinidad and Tobago to discuss NCD-related issues that they plan to address at the Conference. The delegation will primarily focus on how improvements to information technology systems in the public health care system that collect data, statistics and information about patients afflicted by NCDs can lead to better policy making around NCD prevention, treatment and care.  

Meetings during our visit to Port of Spain, Trinidad, brought together researchers from the University of West Indies St. Augustine and public health practitioners at the Trinidad and Tobago Ministry of Health.

Trinidad and Tobago’s involvement in the GHLI Conference is a part of a larger effort to address NCDs in the eastern Caribbean: the country is one of four participating in the Eastern Caribbean Health Outcomes Research Network (ECHORN). ECHORN is a community-based prospective cohort study geared towards expanding clinical research with racial/ethnic minority populations across four Eastern Caribbean sites: Trinidad and Tobago, Barbados, the United States Virgin Islands, and Puerto Rico.

           

The trip was effective in bringing the right parties to the table that have the interest and expertise to tackle the growing challenge of addressing NCDs in the eastern Caribbean. We look forward to continuing the discussion and strategy development at the upcoming GHLI Conference. 

Visiting Brazil to Discuss Early Childhood Development

Shirin Ahmed,

Project Coordinator, GHLI

Some of the GHLI team recently made a trip to Brazil to finalize delegates who will attend our GHLI Conference in June. The trip served as a great opportunity to strengthen relationships with colleagues in Brazil, whose work involves research and programs related to Early Childhood Development (ECD).

During our trip, GHLI met with psychiatrists at the University of Sao Paulo and Universidade Federal de São Paulo, as well as policymakers and NGO representatives who are actively developing strategies to improve early childhood experiences and services in Brazil. Our team gained a better understanding of existing policies related to ECD in Brazil and began to lay the foundation for future collaborations in research and programming between Yale University and Brazil. A visit to a local community offered insight to the country’s primary care system in practice and also helped us understand operations of the local health system and the need to address mental health in these communities. 

In June, our Brazilian colleagues will participate in the GHLI Conference on Yale’s campus and will work with other attending country delegates to develop interventions to improve the mental and physical health of children in the city of Sao Paulo. Brazilian faculty are also exploring a collaboration between Brazil and the ACEV Foundation, a non-profit that has implemented successful parent training programs in Turkey, with potential applications in Brazil.  

One major challenge is the gap between academic research and the implementation of these findings through the public health system. Strategies that the Brazilian delegation will tackle at the GHLI Conference will focus on bridging this gap and integrating research-based, proven approaches to ECD programming into the delivery of public health care in Sao Paulo. We look forward to assisting our colleagues in Brazil with this important phase in improving their health care system.

Similarities: A Healthy Nation and Body

Kristina Talbert-Slagle, PhD,

  Photo by Peter Hvizdak / New Haven Register

Associate Research Scientist, GHLI

A healthy body, like a healthy nation, contains many systems that need to work together in order to defend against threats.  A breakdown of these systems will render both a body and a nation susceptible to invasion – be it insurgency or infection.  As retired Gen. Stanley McChrystal and I recently presented at Yale University, for both the body and a nation to fight off insurgencies, the internal systems must be well organized with a holistic approach to maintaining overall health and stability so the insurgencies cannot win the support of the population in a nation or take over the human body.

We identified and examined how threats to a country and human body are similar. As with the case of the AIDS epidemic and the war in Afghanistan, both are issues that would have benefited from early action and counterinsurgencies. Just as microorganisms infect the body of someone with AIDS by exploiting the unhealthy body’s resources to replicate and spread, insurgents in Afghanistan focused on gaining power in an unhealthy nation in the same way. Sustained stability is essential in both the health of a nation and the health of a body. In Afghanistan, stability is sought by keeping schools open, providing access to electricity, water, and sanitation and aiding farmers as well as in targeting insurgents. To combat AIDS, funding, education and research also prove key factors in building and maintaining health of the body.

When the body’s circulatory, nervous, musculoskeletal and immune systems all work together, it wards of multiple infections every day. When these systems do not work in coordination, the body can be overcome by an infection, as happens with untreated HIV infection leading to AIDS. Medical treatments and social determinants affect the success of the compliance and treatment among AIDS patients. By linking complex systems to fight insurgencies in a nation and infections in a vulnerable human body, we can fight off constant threats and rebuild health. To read a news article about this event, click here.

Addressing Mental Health Issues Around the World

Maureen Canavan,

Associate Research Scientist

Recruitment and Retention of Mental Health Workers in Ghana published in the February 28, 2013 issue of PLoS, once again brings attention to challenges that face health care systems to provide quality care for mental health patients around the world.  Although this particular study was conducted in Ghana – which has an estimated 2.8 million residents with mental health problems, the struggles this country experiences are indicative to challenges also present in other countries.

In the United States, the wave of school shootings has heightened the already existing political and medical battle on how to address and treat those suffering with mental illness. Yet, discussion surrounding building an effective workforce in this area of health care is still at a minimum. More than other areas of medicine, mental health care relies on trained workers rather than technology and tools. This is why GHLI researchers chose to interview mental health workers in Ghana to help determine factors that motivate this workforce. With only 11 psychiatrists serving a population of 25 million people, psychiatric nurses preform most of the direct mental health care.

From our interviews we learned what motivates these workers and what discourages them in the workforce. Motivating patterns include a desire to help patients who are in need, positive daily interactions with patients, intellectual interest in psychiatry or behavior and good relationships with colleagues. Many interviewees also noted being drawn to mental health because of the close bond between workers in this field of health care.  Workers were discouraged by a lack of resources at the hospital, a rigid supervisory hierarchy, lack of feedback on work performance and few opportunities for career advancement within mental health.  

We found that strengthening interpersonal and team dynamics may be a critical and cost effective way to increase worker motivation and ultimately strengthen the mental health care system.

Overall, its seems that whether in Ghana or at any other health care facility dealing with mental illness issues, relationships may be integral to the retention and performance of staff– a key factor in the ultimate success of treatment for mental health patients.  

To read Recruitment and Retention of Mental Health Workers in Ghana, click here. 

GHLI Partners with Uganda to Treat NCDs

Mike Skonieczny, 

Executive Director, GHLI

The global burden of non-communicable diseases (NCDs) like diabetes, cardiovascular disease and cancer is staggering. According to the World Health Organization, NCDs represent 43% of the burden of disease and are expected to be responsible for 73% of deaths worldwide by 2020. Most of this increase will be accounted for by emerging NCD epidemics in developing countries. In Uganda, NCDs have become a pressing issue, and the leadership of the country is determined to act.

Stemming from a relationship with the Yale School of Medicine that began in 2006 with Mulago Hospital, the teaching hospital of Makerere University in Kampala, I recently visited Uganda to meet with key stakeholders to understand the landscape of NCDs in that country and prepare for a Ugandan delegation to attend the GHLI Conference at Yale in June.  During the Conference, health practitioners, policymakers and researchers from around the world convene to facilitate collaborative, locally-driven solutions to improve health.

GHLI’s work with Uganda will focus on developing a strategy to address NCDs. Student and staff support will be offered at all phases to help organize and implement their plan —including sending student fellows back home with the delegates to begin work on the ground in their country. In addition to NCDs, delegations from Brazil, Ghana, and Trinidad and Tobago will also attend the GHLI Conference to share challenges, insights and develop strategies to address mental health and early childhood development.

Our work with colleagues in the School of Medicine and in Uganda is central to our interest in developing strong collaborations that lead to sustainable solutions.  We look forward to working with them and our other delegations to develop new strategies to address growing health issues like NCDs. 

Why We Do What We Do: Patrick Geoghegan

Patrick Geoghegan, OBE, is the first to say that he had no career plan. “I was driven by my passion to do something different,” he proclaims. “And, I looked for every opportunity to actually make that difference.”

In the field of health care for more than 40 years, Patrick has pushed for system reform and transformed mental health services. He currently serves as chief executive for the South Essex Partnership University NHS Foundation Trust (SEPT) – a partner of GHLI. SEPT provides integrated care to local communities including mental health, learning disability and social care services.

Growing up in Ireland, Patrick went to school to become an accountant but quickly realized that wasn’t his calling. He then joined the priesthood, where he assisted mentally ill people and underprivileged communities. He saw that persons with mental health issues are more likely to die 20 years sooner than others because of neglect to their health. The exposure to the daily lives of these disadvantaged groups fueled his desire to help in everyway he could. Though his work with the church was rewarding, Patrick could not make the type of change he wanted behind the walls of a monastery.

To become more directly involved with health care, Patrick moved to England to work at a hospital. He quickly worked his way up from porter to nurse to senior manager to director to chief executive. “I strive to make sure services are available to people and reach out to vulnerable groups -- those who may not know how to access services,” adds Patrick. To help ensure patients receive quality care, he helped establish a feedback system where random patients review their experiences. Both the community and staff praised this initiative for improving doctor patient interactions.

Throughout his career, Patrick always pushed boundaries, questioned policy and stood up to defend those at the corners of his community. He aims to be the voice of the smaller groups who tend to go without because they don’t know how to be heard in the system. 

Patrick is excited to continue working with GHLI and thrilled about the progress the organizations have made in Ghana, but he also looks forward to training the next generation of leaders and passing the torch to future visionaries.