Why We Do What We Do: Rex Wong

About 20 years ago, Rex Wong visited Egypt for the first time. He didn’t know anything  about Egyptian health care, but he was intrigued by the country’s history and culture. Now, as director of hospital strengthening for the GHLI’s Egypt program, Rex has been a resident of Egypt since April 2010 and says it’s been, “A dream come true.” 

Rex came on board to the GHLI program in Egypt about a year ago,   to assess both public and private hospitals. A patient scheduling system that reduced waiting time by about 33 percent and cut hospital crowding by 45 percent were just a few of the successes he shared with me. The Ministry of Health in Egypt also supported GHLI’s program and recently expressed interest in expanding this program to other hospitals.

Rex described living in Egypt and working with GHLI “like a dream" because he’s wanted to work in developing countries for a while. “Since I was a kid, I’ve lived in multiple countries. It’s a part of my personal goals to work internationally,” explained Rex. He was already involved with GHLI after graduating from Yale and was approached by Elizabeth Bradley, the faculty director of GHLI, when the Egypt project presented itself.

Rex was the ideal candidate to the GHLI team because his personal ideology shaped his passion for work. “I like Yale and this program. Most other companies would charge fees to other countries. Instead, Yale is not trying to make a profit. Helping developing countries isn’t about making a profit,” explained Rex. The turning point in his ideology was shaped during his first volunteering experience in South Africa. “I saw the need in terms of health care and even necessities such as clean water and shelter.”

Working internationally, improving education and hospital management are the three things Rex cares about most. He’s doing all three things and says he has no complaints.

Amanda Sorrentino, GHLI Intern

GHLI Continues Strong Relations with Egypt Program

The political unrest and protests were more than a news story for Rex Wong. He was living in it. Rex recently had to leave his home in Egypt – where he works as part of a GHLI at Yale program – and return to the U.S. “I was not seen as an outsider, since I had been living there, so the environment did not feel threatening to me,” says Wong.  “It was actually more of an emotional experience to witness such a historical time in the country.”

As director of hospital strengthening for the GHLI’s Egypt program, Wong has been building relationships with government officials and with the National Bank in Egypt since April 2010. The National Bank has shown great interest in improving health care systems in Egypt by donating hospital equipment and initiating the partnership with GHLI in 2009. In collaboration with GHLI, they’ve created a more sustainable program to improve country-wide health care systems over the long term. Improving patient records, creating a more efficient method for patients to be seen and more effective payment systems are just a few of the GHLI’s accomplishments in the Egypt.

Wong explained how important GHLI’s relationship with the National Bank of Egypt has been during the past few weeks to ensure stability for their program. He’s positive the program will continue, but he noted a lot is uncertain because the health care system relies on the Ministry of Health. GHLI had strong relations with the Ministry of Health, and Wong said he’s committed to reestablishing relationships with the new members of the Ministry now and after their September election’s.

“The more I stay in the country [Egypt], the more I realize the importance of the program. The people I work with are amazing; they are willing to learn, hardworking and committed,” explained Wong. He added he cannot wait to go back to Egypt and continue his work there.

Amanda Sorrentino, GHLI Intern

Why We Do What We Do: Michael Skonieczny

Michael Skonieczny is the executive director of the Global Health Leadership Institute (GHLI), at Yale University, where he directs the program’s operations. Skonieczny’s interest in health issues began from his previous work on domestic health policy issues with the Federal Drug Administration and Congresswoman Rosa L. DeLauro. When he began working for the Elizabeth Glaser Pediatric AIDS Foundation, Skonieczny’s interest expanded into the global arena.

Skonieczny became interested in GHLI after meeting with Elizabeth Bradley over two years ago. Her vision and work in Ethiopia around hospital management presented an exciting opportunity to create something new at Yale. GHLI also presented a new prospect to Skonieczny that was different than his work with health policy in Washington, D.C. He made the decision to join the GHLI team.  

Even though he’s only been at GHLI for a short period of time, Skonieczny said he thinks much has been accomplished. “We’ve created a fertile ground at Yale University for global health with tremendous support on campus from students, faculty and senior administration,” he explained. Since GHLI’s annual conference in 2009, the student course, variety of speakers and development of a potential Rwanda program are a few examples of why he feels the program has been a success. Skonieczny said his ultimate accomplishment at GHLI came from the delegation at the annual conference because it began the collaboration between GHLI and the Ministry of Health in Rwanda. 

Skonieczny expressed a similar sentiment as his fellow GHLI coworkers by saying, “My work makes excited because I believe we can contribute to make a difference. He added, “It’s great to be a part of a group that’s innovative and entrepreneurial.”

Amanda Sorrentino, GHLI Intern

Trip to China: Support from across the world creates success for 10,000 Women Program

Martha Dale, director for China Programs, and Lui Yu, program manager, shared their experiences after a recent trip to China. Martha and Lui’s work provides women in China with the opportunity to learn management and leadership skills that will improve their own health care systems. While Martha and Lui make several trips per year to China, much of their work is done providing support to the program from countries away. 

Both were able to reflect and share their most rewarding aspects of the overall program. Yu explains how he manages the program’s 60 students with regular phone calls and e-mails on a daily basis because he wants to make sure they’re not ignored and still feel a part of the program. Dale adds that watching the group dynamics, team roles and applicable skills develop is the most satisfying part of her trip.

Dale explains that the program began when Tsinghua University decided they wanted to do more work in health care and connected with Yale University because of their past work with China. After both universities connected, Elizabeth Bradley, faculty director at GHLI, took the lead to develop a proposal for funding the initiative.

The program focuses around a three week certificate class and a four month field assignment. Dale explained the main purpose of the program was to create a profession of health care managers and to increase the efficiency and quality of health provided. The program is funded by the Goldman Sachs Foundation, and provides women in lower category hospitals, but with a wide range of health care experience, the opportunity to improve their health care management outcomes. Students have been recruited thus far from 18 of China’s provinces.

Success in the program is measured through a series of complex monitoring evaluation systems consisting of competency, leadership, projects, promotion and gender roles. These five constructs involve evaluating skill sets before and after, how the project’s impact the community and if men or women are perceived to have more dominant roles in the workplace or home. Yu explained one example of success is measured by comparing the initial skill sets of students in the cohort to their present abilities at the conclusion of the program. Another measure is through field assignment work: one student’s project increased the recognition rate of diabetes within their community. Two classes of students have graduated and the program is currently working on their third. The certificate program aims to graduate eight groups in total.

Amanda Sorrentino, GHLI Intern

Global Health Discussion on Innovation and Scale Up

During the first ever Global Health Faculty Symposium at Yale, expert faculty explored global health research puzzles in depth. Elizabeth Bradley, Linda Arnold, Mark Saltzman, Mushfiq Mobarak, and Nancy Reynolds were some of the faculty who participated in the innovation and scale up discussion group. Faculty, across various disciplines, were able to share more details about their specific research projects and discover additional information about their research endeavors.

The discussion began with Dr. Bradley identifying the different paths that can lead to product design adoption after innovation. The first path is when great technology stops dead in its tracks because of diffusion. An alternative is priming the political and economic environment. For example, lowering the price of complements and increasing the price of substitutes can make the benefits of diffusion outweigh the costs. Finally, the third pathway is engaging social norms and DNA fabrics of a community. This means the product may have to come from the community, rather than from outsiders. Dr. Bradley explained this through an example, “Like a virus moves through the cell, the virus has to embed into a cell to reproduce, this is how the community would reproduce an innovation. That’s how things diffuse.”

Mushfiq Mobarak explained how innovation and scale up is about more than just countries adopting technology to improve their health, but can help a researcher learn additional information about human behavior. For example, his research on a scale up for a government credit program to encourage seasonal migration away from famine in Bangladesh helped Dr. Mobarak learn availability of information, money or employee relationships, are different determining factors of migration.

Most faculty members agreed that Yale University’s involvement and advocacy of researchers are two necessary components for innovation and scale up. Finding a balance between faculty’s interests in global health could create opportunities for student involvement. Dealing with the unintended effects from innovation and scale up were harder to agree upon.

For example, Dr. Bradley explained how the world may adapt a product differently than it was intended, but how this isn’t necessarily a bad thing because communities can still maximize their welfare. Another faculty member thought, as a researcher, you are responsible for how an innovation is presented to the world and how it should be used. The interaction between two different innovations and designs should also be taken into account. Nancy Reynolds discussed how female condoms in Uganda may not be compatible with Mark Saltzman contraceptive design.

The discussion concluded with Lubna Pal asserting a needs assessment is necessary to help address and prioritize problems with vulnerable populations. Dr. Mobarak suggested potential next steps. Yet, no matter what the next steps are for innovation and scale up, the discussion is the main vehicle for faculty collaboration and understanding.

Amanda Sorrentino, GHLI Intern

Faculty Collaborate to Piece Together Global Health Puzzles: Part II

       The faculty panel session ended with faculty sharing their expertise on two additional global health research puzzles followed by a facilitated discussion, lead by Elizabeth Bradley, Director of the Yale Global Health Initiative.

Maria Diuk-Wasser, assistant professor of epidemiology, presented the global health puzzle on climate change and health. Her research centered around the question, “How do we assess vulnerability to the health effects of global climate change on the multi-scale ecological and social processes that contribute to disease?” Examples of climate change effects from environmental stressors included extreme temperatures, air pollution, vector borne disease and water borne disease. These new climate changes could increase incidence of heat and cold stress, cardio and respiratory response, malaria, dengue, cholera, food security, malnutrition, forced migration and even human conflict at the global level. One of her examples of this puzzle illustrated vulnerability at the community level. A map of the United States highlighted regions with higher incidents of heat mortality.  The regions with greater mortality clustered in the North, where temperatures are cooler on average than in the South, where temperatures are higher.  This lead to an interesting discovery by proving not everyone is equally vulnerable and mortality rates coincide with adaptability to heat.

The next panel, lead by Elizabeth Bradley, discussed examples of relatively inexpensive and cost-effective technologies and behaviors that are not widely adopted, called innovation and scale up. Innovative technologies directly impacting health included contraceptives and medications. Unique products also included cooking stoves that help improve respiratory health issues. Barriers for new technology adoption include both demand and supply side incentives, such as lack of information, taste and tradition, credit and savings constraints and inappropriate design.  One new design being tried to overcome men’s relative lack of interest in cooking stoves included manufacturing a cooking stove that could also charge a cell phone. 

With the completion of the panel, Elizabeth Bradley facilitated a discussion to connect global health research puzzle topics. Although the discussion was relatively brief, faculty addressed about an array of global health topics that included: how government can enact policies impacting global health, visions for global health now and for the future, how vulnerable populations can be protected and the role genetics plays in global health research.

Faculty showed their commitment to collaboration across multidisciplinary platforms during the symposium. One comment during the facilitated discussion expressed the common sentiment for global health meetings to continue to help build relationships between departments.

Amanda Sorrentino, GHLI Intern

Faculty Collaborate to Piece Together Global Health Puzzles: Part I

The Global Health Leadership Institute (GHLI) held the first ever Global Health Faculty Symposium at Yale last Friday. More than 75 faculty members, across multiple disciplines, gathered together and to share their expertise on five global health research puzzles during a faculty panel of which I cover three here.  

The topics began with food insecurity and obesity, lead by Dr. Tian Xu. This puzzle explained how scarcity of food could lead to both malnutrition and obesity. Dr. Catherine Panter-Brick’s panel on conflict, resilience and health immediately followed. Using Liberia and Sierra Leone as examples, she discussed her research findings. By comparing risk-conflict and resilience, Dr. Panter-Brick established why risk-conflict is bad for health at the global level. On the contrary, resilience, defined as enduring adversity, can help maintain relatively stable, health, functioning over time. This puzzle presented a resilience paradigm, because studies investigating resilience had a high incidence of risk and violent conflicts.   

Dr. Albert Ko shared his research on global infectious diseases. Dr. Ko explained how Yale had a long history of research in global infectious diseases and had established research partnerships with other countries, but could not identify one single key global health puzzle. Instead, the research focused on understanding syndemics, or how two or more diseases interact with one another. The global impact of issues such as HIV and drug addiction as research on syringe exchange programs was addressed.

Dr. Ko stressed the role of social equity as a essential component of multidisciplinary approaches in developing effective interventions for vulnerable populations. His research has already been used for global health interventions. For example, health care service research has strengthened Tuberculosis infrastructure and integrated its services with HIV. This has allowed for an increased availability of drug development for TB.    

Although these three panels were informative, additional global health puzzles were uncovered by faculty throughout the day. Look out for a new blog about additional global health research puzzle panels from the faculty symposium and global health discussion groups.

Amanda Sorrentino, GHLI Intern

Global Health Fellowships at Yale: Apply Now

In order to train the next generation of global health leaders, the Global Health Initiative at Yale is putting their money where their mouth is. On Wednesday evening, Kaveh Khoshnood, Director of Global Health Fellowships, led an informational session on the three major funding opportunities for global health internships and research under the Initiative. The Yale College Health Studies Award targets students interested in field research while the Global Health Initiative Field Experience Award and Yale - Collaborative Action Project (Y-CAP) Award are more flexible in nature, supporting research, practice, advocacy, or policy and management. You’ll find a full listing of fellowships here.

The most unique of the three fellowships is the Y-CAP Award, which supports a team of three to four undergraduate and graduate students from multiple disciplines with up to $15,000. The grant actually originates from past demonstrated student interest in collaborative projects. Given that "no one works alone in the field," Professor Khoshnood lauded the prize as "finally a mechanism to fund what we preach." As a donor driven fellowship, the fund will most likely support one team, with a preference for projects in Africa. It is surprising to think that there is not more support for synergistic studies not only in health, but other fields as well.

One of the key features of the GHI seems to be its ability to bring together a multidisciplinary force, evident in the thirty plus undergraduate and graduate students circulating at last night’s funding session, pitching proposals and creating Y-CAP teams. Hopefully, the Y-CAP is only the beginning of encouraging collaborative scholarship in global health at Yale.

Connie Cho, GHLI Intern