August 18, 2015

Safety’s Impact on Physical Activity in Brazil

Yaphet Getachew and Jennifer Mandelbaum,
2015 GHLI Fellows

We often hear parents complain that their kids spend too much time on the internet or they are too lazy to play outside. But, in Brazil, it’s not lack of desire among kids to be active, there is a far more serious reason why physical activity is a challenge – safety.  

As part of our GHLI fellowship this summer, we spend time in Brazil observing the Agita São Paulo program – designed to prevent childhood obesity through physical activity. During our first week in Brazil, we visited the island of Ilhabela to learn about efforts in both elementary and middle schools to help kids be more active. 

We met with representatives from the Secretary of Education and learned about the very real barriers to physical activity facing children on the island. For example, even though they’re surrounded by water, the majority of children and their parents on the island do not know how to swim. Parents worry about violent crime, causing them to keep their children indoors most hours that they are not in school. And, so the only real safe space students have to exercise is within the schools. This leads many children to spend their free time playing video games or watching television and being sedentary instead of playing sports outside with their peers. Students are typically only in school for half of the day, leaving many hours of unscheduled time, which is why the development of active after-school programs is crucial.

Given these barriers to physical activity, Ilhabela has made strides to provide outlets for physical activity in schools. For instance, the schools we visited had recently built an athletic facility, which included a basketball court and a pool. Our visit to the schools gave us a much clearer picture of the physical activity environment theses kids can access and helped us develop recommendations for Agita’s future programs. Maybe more importantly, we observed how a community bands together to tackle a major problem for its children.

August 12, 2015

UK and US Health Systems: Can we Learn From Each Other?

Brittany Stollar, 2015 GHLI Fellow

Before this summer, I had almost no knowledge of the structure, the effectiveness, or the political implications of the National Health Services -- the United Kingdom’s health care system. When I joined GHLI as an intern, that quickly changed. My first project involved researching the impact of NHS reform on the recent elections in the UK. What really made this experience special was not just that I was learning about the NHS in greater depth, but I got to hear about certain details first-hand when our UK colleagues visited the Yale campus this summer. 

During the week-long Forum, I was surprised to realize how little I really knew about health care systems outside of the U.S. I knew our health care expenditure per capita was much higher than most other countries, but never truly understand to what degree and that we spend more than $2000 beyond that of our closest competitor while still having health outcomes consistently below the average of our peers. I was also shocked by how partisan the Affordable Care Act has been. Unlike in the UK, there is no agreement between the parties on any of the issues raised within the ACA.

Coming from a country that has practiced universal health care coverage since 1948, the UK delegates struggled to understand our political conflict over the ACA. I found myself struggling to understand as well. I hadn’t realized that I’d grown accustomed to debates over the basic human right of available, accessible, affordable, and acceptable health care. While the delegates learned about how to improve the NHS by looking at our system, I learned how we could improve our system by looking at the NHS. During this week, the concept of national agreement on universal health care became less of a myth and more of a feasible possibility.

August 4, 2015

Diabetes and Hypertension in the USVI

Gianna Kinsman, 2015 GHLI Fellow 

This summer, living in St. Croix studying the challenge that non-communicable diseases pose to the United States Virgin Islands, I soon observed the carbohydrate- and fat-rich local diet that often includes bread, macaroni, pate, or yams. The reality of having to ship most goods to the islands by plane means that produce, like other healthful, perishable food, expires quickly. Many of the restaurants are fast food chains that also provide high fat foods which further impacts my areas of study -- diabetes and hypertension.  

Since the individual insurance mandate of the Affordable Care Act does not apply, USVI expanded Medicaid rather than establishing an insurance exchange, but nearly one third of the population remains uninsured. Even to insured citizens, health care costs can pose a significant problem. Although many educational programs about diabetes exist, efforts to implement such a program in the USVI have failed due to a lack of funding and because most citizens cannot afford repeated copays to attend classes. During my time in the USVI as a GHLI Fellow, I hope to help the delegation rectify challenges such as this and other NCD issues.

While working with Frederiksted Health Care and Governor Juan F. Luis Hospital & Medical Center, I collected data on patients with diabetes and hypertension, and also interviewed providers about existing options for management of diabetes and hypertension on the islands. From these interviews, I learned about past community-level programs to educate patients on diabetes management, the burgeoning development of a unified electronic health record, and initiatives to improve overall patient health and the patient-provider relationship, such as brown-bag medication reviews.

I’m enjoying my stay in the USVI and found my role as fellow rewarding as I help my delegation develop a strategy to reduce the prevalence of advanced complications of these widespread NCDs.

July 28, 2015

Children and Armed Conflict in Colombia

Chanel Marin , 2015 GHLI Fellow

Colombia has been immersed in an armed conflict for over 50 years. The underpinnings of the conflict have evolved over time, but its consequences have remained the same: mass displacement, violence, and death. The impact of exposure to violence on children in Colombia continues to grow as one of their biggest public health challenges.   

I am currently in Bogota, Colombia working as a GHLI fellow with Fundacion Saldarriaga Concha on a project to strengthen resiliency and peacebuilding in children under age five affected by the armed conflict. GHLI is working with the foundation to evaluate the impact of this intervention and my role is to develop, refine, and carry out focus groups and interviews with child caregivers, teachers, and government stakeholders. I work daily with a group of dedicated colleagues who bring me on field visits to witness how the intervention is being implemented.    

The visits were an incredible opportunity to meet the children impacted by the intervention. On one occasion I ate lunch with the children and assisted in their play and nap time. They were happy, energetic, and very curious about the new adult at the center. During the visit, I interviewed mothers regarding their experiences with conflict and their children’s behaviors. These brief interactions gave me a sense of how displacement has affected large portions of the population and how this impacts young children.

As my time in Colombia draws to a close, I am grateful to have worked with such a passionate team and to have learned how an intervention is implemented from the ground up. I have experienced the incredible kindness, warmth, and spiritedness of the Colombian culture and will take that with me home.

July 23, 2015

Treating Alcohol as an NCD

Wendy-Ann Wattie, Ministry of Health, Trinidad and Tobago

Alcohol is the most widely used, accessible drug in Trinidad and Tobago. It is a risk factor for many non-communicable diseases (NCDs), but is also associated with a myriad of other health and social problems, including the spread of sexually transmitted diseases, violence, accidents, injuries and road fatalities. A group from T&T, comprised of five country participants from the Ministry of Health and the University of the West Indies, recently convened at Yale for the GHLI Forum for Change to discuss the issue of alcohol use and abuse. While we had planned to discuss the relationship between alcohol and NCDs, the team agreed that the damaging impact of alcohol consumption superseded exclusive focus on NCDs and that a more comprehensive strategy was necessary to tackle this problem. 

We found the Forum to be a creative, thought-provoking environment at which we could collaborate with not only Yale faculty but also with our Eastern Caribbean colleagues in attendance focusing on their own specific NCD issues. Dr. Rohan Maharaj, principal investigator, ECHORN: Trinidad and Tobago, helped our group involve senior officials and successfully motivate the team. Our strategy discussions and development evolved from early conversations on the complimentary role of followers to leaders and embracing and tackling implementation challenges; to problem solving tactics such as identifying a champion and developing a National Policy on Alcohol, that we hope to implement over the next few months/years.

There were a few unforeseen events that we had to overcome, like skyping our absent T&T countryman to maximize participation benefits and getting prompt health care for our fallen Barbados counterpart, but it was met with an energetic and effective response. After dinners with faculty and staff and an outing at a local orchard, there were clear personal and familial contributions of GHLI and ECHORN members that signaled their humility, grace, sincerity and infectious commitment to achieving the shared purpose of global health. 

July 20, 2015

The Challenge of Treating Diabetes….in Barbados

Sequoia Leuba, 2015 GHLI Fellow

Diabetes in Barbados?  Not something I had ever thought about before this year.  But, when I applied to be a GHLI Fellow, I learned an estimated one in five Barbadian adults has diabetes, and more than 40% of beds in the island’s largest hospital are occupied with diabetic patients. Now I am in Barbados – helping leaders from diverse backgrounds develop and implement a strategy to address this problem.  

While several successful programs have been implemented, the fragmented care is unable to address the growing diabetic population. I travelled around the island learning first-hand about the strengths and weaknesses of each program, implementation successes and challenges, and how the program structure could be incorporated in an expanded island-wide approach. After many lively discussions, the Barbados delegation plans to implement a system redesign in public and private primary care clinics. To support this endeavor, I will spend part of the summer evaluating the current state of diabetes and its care in Barbados.

In addition to working, exploring Barbados has led to great adventures. A short excursion to see a delegation member play piano at a local restaurant ended up being an unanticipated undertaking, as going from the restaurant to the boat club where the party was moving involved walking in the drizzle to the boardwalk, and traveling on a dinghy, to a sailboat, to a leaking kayak, to wading in the beach, all in a maxi skirt that kept ripping. Arriving drenched, I was exhilarated – a feeling I consistently have, whether working with a magnificent team or having remarkable experiences.