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.

August 21, 2014

Building Capacity for Mental Health Care in Ghana

Austin Jaspers, 2014 GHLI Fellow

Even before my time in Accra as a GHLI fellow reached its endpoint, I started plotting ways I could return and continue Yale’s long-standing partnership with Ghana in the area of mental health. This summer, I contributed as a member of a team dedicated to improving community-based mental health care in Ghana. Stakeholders and experts hailing from both sides of the Atlantic exchanged big ideas, new concepts and countless drafts as we moved forward in designing a new training program for the Psych Corps.

I learned about lay counseling and mental health care from the standpoint of a practitioner while simultaneously supporting the high-level operations of the Ghana Psych Corps.  As part of the National Service scheme, the program faces the unique challenge of refreshing its entire workforce on a yearly basis while attempting to build upon collective experiences.

In collaboration with faculty at Yale to gather data from community mental health workers and conducted qualitative interviews which enabled us to understand the Psych Corps’ role in the broader health system and identify opportunities to improve the program. 

I worked with colleagues in Ghana to build a sustainable and effective supervisory structure for Psych Corps. This improved framework will be part of the training toolkit we will present with our colleagues from Ghana at the GHLI Forum for Change in Accra this fall.

With the Psych Corps serving on the frontlines, I am optimistic that Ghana will steadily grow its capacity to deliver mental health services in the coming years.

August 20, 2014

Leaving Trinidad with Much More than a Side ah (sada) Roti

Ffyona Patel, 2014 GHLI Fellow

As I reflect on my fellowship with Trinidad’s South-West Regional Health Authority (SWRHA), I am energized by what we have achieved and what I am taking away. When I arrived, it became clear to me that the idea to pilot test a health information system (HIS) around non-communicable diseases (NCDs) had long been birthed but not quite developed. Toward this progress, stakeholder awareness around the idea, its roots and its benefits needed to be established and the project steering committee’s foundation, objectives, and next steps needed to be solidified.  

In the weeks that followed, I delivered project briefings to different SWRHA stakeholder groups, allowing them to learn about and engage directly with the project. Audience members shared ideas on how to develop a sustainable HIS to facilitate treatment and prevention of NCDs based on their unique roles.  

I also helped establish and routinize the steering committee’s action-oriented meetings – ground work which will hopefully create project champions among committee members and lead to a comprehensive pilot project. 

I learned that communicating information across stakeholders can empower.  This empowerment can translate into knowledge sharing and on-the-ground commitment toward project success; this has proven true for SWRHA’s vast system where stakeholders may have felt that system-level changes affected them but could not be affected by them. 

Thank you, SWRHA, for your hospitality. You demonstrate that health care leadership happens every day across many supportive, administrative, clinical, and managerial staff that work to provide quality patient care. I look forward to seeing your flourishing HIS for NCDs come to life and set precedent for T&T as a whole.

August 14, 2014

Obesity and Healthy Living Across the US

Source: http://prafulla.net/life-style/america-land-of-the-obese-infographic
Lea Hamner, 2014 GHLI Fellow

Over the past few months, I have travelled to five counties across the US to better understand why certain regions in a state have lower obesity rates than similar counties in the rest of their state.  I work with a team of GHLI researchers who seek common themes across these counties in order to examine what may be replicated elsewhere to foster a community of health and reduce obesity rates. Some of these counties seem like an obvious pick to me—an urban setting, a progressive culture, an abundance of outdoor activities. Yet, we also encountered some tiny rural counties in the middle of nowhere that somehow seem to be doing things right.

One of our visits was to a county with a total population of about 25,000. We stayed in the one hotel in town at the center which was about a mile stretch of road. Everyone not only knew each other – but it was quickly evident that they genuinely cared about each other. We conducted 10 interviews asking participants why they thought this town was able to keep obesity rates down. Each interviewee was remarkably candid and excited about the work being done. Within an hour of our individual chats, we had a comprehensive understanding of the county—as well as a group of new friends who welcomed us into their community. They were so inviting that we were welcomed to pick green beans with one interviewee in her intentional-living community. The chipper attitude, hope, and resiliency of these individuals were palpable. This success and progress was not what I expected but I will happily admit that this county had fostered an incredible culture.