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. 

July 13, 2015

“Providing Equitable Health Care the U.K. Way”

Modupeore Shenbanjo, 2015 GHLI UK Fellow

Before becoming a graduate student at Yale, I worked as a research assistant in adolescent medicine where I observed multidisciplinary teams caring for patients struggling with eating disorders, drug addictions and teen pregnancy. I often heard in my classes at Yale about how the National Health Services (NHS) provides equitable health care at the point of service. And, now I’m able to see firsthand how the East and North Hertfordshire NHS Trust ensures that no one “falls through the cracks” of health care. 

In my role as a GHLI Fellow, I have been able to interact with the trust management, divisional directors, general managers, service coordinators as well as consulting physicians to assess surgical theatre efficiency such as investigating reasons for late start times for the first patient of day and blockages to quick turnovers in between patients. 

Through various conversations within the trust, it is evident that not only health professionals, but also the general public are proud of their health system and are determined to ensure they continue to meet the expectations of their citizens. 

While observing a surgical procedure, I was impressed at how nurses as well as clinical support workers ensured that each surgery had all the necessary equipment and anticipated possible complications. I also noted that even in a specialty as busy as surgery, senior staff members understood the value of good management and leadership to ensure the needs of each staff member is met and to ensure they create an environment that continues to support learning. 

I have been able to utilize my past research skills, as well as my knowledge gained from my courses in order to collaborate with consultants and investigate the root causes leading to surgical starts and cancelations. It’s been an exciting, informative journey thus far.

July 6, 2015

Uniting for Childhood Health in Puerto Rico

Geoff Soybel, 2015 GHLI Fellow 
The prevalence of childhood obesity in Puerto Rico has been estimated to be as high as nearly 30%. This statistic demonstrates that the youth of the island territory are less fit than their counterparts in some of the unhealthiest areas of the United States. This harsh reality is not lost on locals.  
Being in Puerto Rico as a GHLI Fellow, I now see how the eastern Caribbean island, and many organizations, both public and private, are taking steps to alleviate the health burden. The problem is that most efforts are conducted independently, and there are very few mechanisms in place to evaluate their effectiveness. Childhood overweight and obesity initiatives are so disjointed, in fact, that some offices at the same organization are unaware of their coworkers’ contributions to the cause.  
This is where GHLI’s Puerto Rico delegation can help. In order to maximize health promotion results, or determine if they are working at all, the delegation understands that local stakeholders must come together. Without unifying efforts toward the same goal, it is impossible to know what accomplishments, if any, have been achieved. In many ways, the work that we’re doing with GHLI is focused on removing our proverbial blindfold, so our path to Puerto Rican childhood health is clearly visible.  
My time here in Puerto Rico has been wonderful! The sunny weather is ideal, and my office is situated in the Medical Sciences Building of San Juan’s Centro Medico, which is only a five minute train ride from my lodging, so dealing with the frustrations of a morning commute is a non-issue. 
Dr. Capriles, one of our delegation members, brought me to sample the delicious local fare of bacalaitos and alcapurria (salted cod fritters and deep-fried, meat-filled dough). The trip was both enjoyable and educational, as it became clear that the island’s food tradition is one of many factors we must consider to successfully approach local childhood overweight and obesity prevention.

June 24, 2015

“To be amongst the best…”

Drew Weil, 2015 GHLI U.K. Fellow
You don’t have to go far to find a British citizen that is proud to receive health care through the National Health Service. It is one of the country’s sparkling achievements and a system that people from every social class and demographic endear. 
My fascination for how the U.K. can care for literally every member of their society so well was what drove me to this GHLI fellowship working for the 12 weeks with the East & North Hertfordshire NHS Trust. And subsequently, I wanted to understand what can we learn and apply to improve our own U.S. healthcare system. 
My work here is largely focused on improving the care and services provided for frail and elderly people. I believe that the way a country and health system cares for their most vulnerable populations is a good test of its conviction to humanity and civility. In this Trust, there are many stakeholders eager to work towards and progress forward with this aim. 
However, with a more diverse stakeholder group, also comes opportunities for redundancies and inefficient work processes. I am able to work with each of these groups – which include community health care providers, social service leaders, NHS commissioners, hospital administrators, physicians, government representatives, and others – to find a common approach to improving care and healing that is provided. I’m excited and feel a sense of accomplishment when I can apply concepts I’ve learned in my Health Care Management coursework and past work experiences. Whether it is interpreting data, discussing the economics of the NHS, or watching the hospital operations in real-time, it is an amazing feeling to see the pieces begin to come together.
Although the weather is typically grey and overcast, the people have been warm and cheerful. It is an inspiring group of people to work with, and it makes it very easy to wake up, be motivated and want to contribute-to and improve their community! “Cheers!”