April 17, 2014

Unifying our Approach to Mental Health

Andres Barkil-Oteo, MD, MSc, Assistant Professor of Psychiatry, 
Yale School of Medicine 

I was invited to visit Ghana by GHLI to discuss the incorporation of a mental health component, known as the “Psych Corps,” into Ghana’s National Health Service. Ghana graduates 300 psychology students per year who serve one required year posted to clinics across the country. 

This is the second year of the program and we see many issues that still need to be addressed, but largely the feedback was positive and Psych Corps members look forward to expanding the program. Why were my team and I involved? Although none of us had ever been to Ghana, and its culture and customs were foreign to us, somehow the setting felt familiar.  

For the last two years, our group has overseen a student run clinic in New Haven, CT offering behavioral health services to a large, undocumented Latino population in a low income neighborhood. The problems of lack of access, stigma, and lack of professional staff in Ghana’s clinics mirrored many of the problems we face in the U.S. We shared our model with our Ghanaian counterparts, and sought feedback from a group of enthusiastic nurses and psychology graduates on how this could be adapted to their current situation. We, in turn, learned from them how to go about performing outreach and home visits, things we currently lack in our complex, hospital-focused system. 

Our travel to Ghana further illustrated to us that problems of access are universal, as are problems of under utilizing evidence-based therapies, and problems of marginalization and stigma. We need to change our mental perspective to one that assumes that we all deal with similar problems, with differences in intensity, but not in kind. Students wishing to work in the area of global health would be well advised to find a similarly local under-resourced setting, where they could learn skills and practices not taught inside large hospital settings; only then could they approach global initiatives with a mentality of solidarity rather than a mentality of difference. After spending a full day with Psych Corps, exchanging ideas, I came back optimistic about this collaboration, and look forward to continuing the shared learning experience.

March 20, 2014

My Week in Ghana

Katherine Bradley, Yale '17

Recently, I traveled with a team from Yale’s Global Health Leadership Initiative and witnessed the treatment and lack thereof, of those dealing with mental health issues in the country of Ghana.  GHLI has partnered with senior health practitioners, policymakers, and health care officials for several years to assist their efforts in treating those with mental health disorders.  Our team spent a majority of the time in Accra where we visited Accra Psychiatric Hospital, and met with the Ghana GHLI delegation to discuss progress made to improve mental health care. 

My most memorable experience of this trip was visiting the small city of Koforidua to better understand how the mental health care system works outside of Accra.  During our day there, the community psychiatric nurse scheduled many activities. We first met with the regional health director and the director of the regional hospital. We then went on home visits where we followed community outreach workers who remind patients to return to the hospital for follow up treatment including medication. We also a visited a clinic focused on child mortality, and a prayer camp. The prayer camp housed mostly mentally ill patients who were there to pray their sickness away, but they were also given medicine by the local hospital through outreach by a community psychiatric nurse. 

The day was overwhelming, but also inspiring as I witnessed the passion that the mental health staff had for their work.  With no additional government funding beyond their basic mandate, the staff at the regional hospital managed to find funds to create a new psychiatric ward with eighteen beds because they knew it was important.  I also saw dedication of one psychiatric nurse, Akosua, who took it upon herself to start "Project Dignity," an initiative where staff rehabilitates homeless persons with mental illness.  
Discussing the challenges of improving mental health care in Ghana for the first half of the week, I could see there was a long way to go. After meeting the frontline people who were making this happen, I had a lot more hope that Ghana could achieve their goal of improving mental health care. 

March 11, 2014

Why We Do What We Do: Philip Morgan

From Africa to Asia, Philip Morgan, Physical Rehabilitation Program Manager at the International Committee of the Red Cross (ICRC), has traveled the world with strong sense of humanitarianism, and desire to combat certain issues he has seen again and again related to global health. 

After joining the ICRC six years ago, Philip now works in low-income countries where he applies his expertise in both humanitarian efforts and in prosthetics and orthotics. He was recently named a facilitator for the Regional Senior Leadership Program Implemented by Yale GHLI and Management Sciences for Health through the USAID-funded Leadership, Management & Governance Project.  The Program provides senior decision makers with the skills they need to address health system challenges. Equipping these national teams to improve their respective country’s enabling environment for disability and physical rehabilitation services will enhance USAID and ICRC’s ongoing efforts to establish and improve accessible and appropriate prosthetic, orthotic, and physical rehabilitation services.

Philip facilitates the team from Sudan comprised of six senior leaders from government and non-profits, clinical and non-clinical, who focus on disability issues. “It is a challenge to get the team members together, due to their busy and varying schedules - but with support from Yale GHLI team members and MSH we are able to manage the team and develop solutions,” he explains. Philip finds it particularly interesting that despite participants’ various backgrounds, they have all been able to unite over a common commitment to the program.

“The response from the first session has been overwhelmingly positive,” says Philip. “I hope the students continue to pursue this work. Forging strong alliances across borders would help provide further support to each other’s programs, and certainly help develop policy with regards to disability issues within each country.”

Philip sees great opportunity for continued work in Sudan and hopes to support the work of the National Authority for Prosthetics and Orthotics (NAPO) and their plan to set up a school of prosthetics and orthotics within the country. With only 25 specialized clinicians to serve the needs of over 130,000 people in Sudan with physical disabilities, there is a great need – and Philip wants to help work towards a solution.  

March 5, 2014

Yale Women: Health Innovation and Entrepreneurship

Seth Nigrosh

As an international relations major at Connecticut college, classes that relate to public health and global health were not on my radar for a long time. I have recently become interested in the subject, and realized that as senior year was coming to a close, I had few ideas about what a job in the global health industry would look like. When I had the opportunity to attend Yale's “Women in Innovation: Leading Yale Women in Social and Healthcare Startups” panel discussion I was eager to go. All three panelists, Barbara Bush, YC ’04, founder of Global Health Corps; Jennifer Staple-Clark, YC ‘03, founder of Unite for Sight; and Laura Niklason PhD, MD Yale faculty and co-founder of Humacyte explained origin of their respective organizations and how they ended up at the forefront of the global health community.

I was curious to hear how people who do not have any sort of health or medical background can still be involved in a global health project. When Ms. Bush spoke about her time at Yale as an architect student and Ms. Staples-Clark talked about the importance of removing barriers to care, I realized that global health is an inherently interdisciplinary undertaking. Scientific work by people like Professor Niklason, whose research into regenerative tissue and arterial implants is breaking new ground, will always be needed. But, we also need people who are experts in logistics who can get new medicines and technologies around the globe, and advocates to keep up pressure on public figures to respond to global health crises. I used to ask myself, “Should I have majored in IR? I love it, but I don't want any of those traditional government or finance jobs!” Now, I see that instead I should be asking myself, “How can I take what I've learned and apply it to a complex and intriguing field like global health?” In today's interconnected world, it's not just what you know, but how you apply it creatively, that matters.

December 23, 2013

Lessons on Counterinsurgency from the Human Body

Kristina Talbert-Slagle, Ph.D., GHLI Associate Research Scientist

The worlds of public health and war don’t often collide, but over the past two years I have had the opportunity to work with retired General Stanley McChrystal relating my research on HIV/AIDS to counterinsurgency warfare strategy. When we compared notes, we found many parallels between a human body that is under attack from infectious disease and a nation that is under attack from an insurgency. 

This month, Gen. McChrystal and I spoke at the Brookings Institution in Washington, DC. where I outlined the basic theories behind infection and the human body’s immune system response to disease – specifically, how infections in the human body can be “outmaneuvered” by the body’s defenses. Similarly, Gen. McChrystal noted that, “Human bodies aren’t the only things that get infected … if you think in terms of a nation … you can have infections, and we’ll call it insurgency … that are threats to a nation.”

We compared the way HIV destabilizes the human immune system and enables opportunistic infections to the way that long-term instability in Afghanistan enabled the Taliban insurgency. Success in treating the HIV virus is not simply about anti-viral drugs – it’s more than just rebuilding the immune system. It is a multiparty, multi-aspect approach to rebuilding health. In a similar way, counterinsurgency requires a multi-faceted and holistic approach rather than a single, magic bullet solution. Ultimately, in both cases, sustained stability is the essential factor for both healthy bodies and nations.

After our presentation, Gen. McChrystal and I took questions from audience members and reporters, which included, "Can this model be applied to help us understand challenges to the health of the world, such as climate change?" and "How can we apply the role of stigma to our understanding of improving health?" The genuine interest in our work was a rewarding part of this experience.

This work is truly helping me to understand that counterinsurgency and public health strategies have more in common than I once thought...we ultimately share the same goal, which is to help people live happy, healthy, peaceful, productive lives.

Click here to get the full audio from our presentation at the Brookings Institution.

November 26, 2013

Saving Lives with Primary Care Programs in Low-Income Settings

Leslie Curry, Ph.D., GHLI researcher

Many efforts have been directed at strengthening rural primary care services for women and children in low-income settings.  But few studies have examined the sustainability of these programs or the potential long- term impact of these interventions on the mortality of women and children.

Researchers at the Yale Global Health Leadership Institute (GHLI) evaluated the impact of the Ethiopian Millennium Rural Initiative (EMRI) in terms of lives and money saved. EMRI was a systems-based intervention to improve the performance of 30 primary health care units each servicing 40,000 people living in rural areas of Ethiopia.  Their findings are published in the November 18, 2013 issue of the Public Library of Science journal.

“We found multiple areas of this program were impacted -- including the health system infrastructure, human resource capacity and utilization of HIV treatment services,” explains Leslie Curry, Ph.D., GHLI researcher and paper co-author.  “Most notably, we discovered impressive cost-effectiveness in terms of lives saved over five years of follow up.  The study found that initial investments in critical areas such as access to water and electricity and improvements to buildings, provide far-reaching benefits for health care delivery in rural settings.  The program also expanded care and treatment services for HIV patients.   In addition, investments in system-wide improvements (such as supply chains and laboratories) were shown to noticeably strengthen the capacity of the rural health care system.   If this model is scaled up, the four major regions of Ethiopia could save nearly 35,000 lives.

“This large project not only implemented and evaluated a program to improve rural health care across several sectors,” explains Curry, “it also required developing leadership capacity all across the health care system.”  The researchers hope these results will be used in Ethiopia as they continue with their plans to improve primary care systems nationally.

The analysis underscores the particular importance of sustained performance in driving cost effectiveness. Although the pay back in terms of lives saved did not translate to cost savings in the first 18 months, within five years of sustained performance, the benefits far outweigh the costs of the program.

The researchers hope these results will be used in Ethiopia as they continue with their plans to improve primary care systems nationally.