Prayer Camps to Treat Mental Illness in Ghana

Alice Bradley, GHLI volunteer

Recently, I had the great opportunity to serve as a research assistant with the GHLI during a trip to Ghana to observe the state of mental health in that country. So many aspects about my trip with GHLI to Ghana were memorable, but it was the tour of Mt. Horeb Prayer Camp that I remember most vividly.

These religious communities (varying denominations) offer treatment to people with mental illness. They are a popular alternative to psychiatric hospitals, with 70 prayer camps just in Greater Accra. The camp leaders view mental disorders as demons inside a person and do not use psychiatric medication, but rather a regimen of fasting, prayer, and beatings to expel the demons.

Beginning our tour, I expected to be immediately outraged, but instead I was caught off guard with the natural beauty of the jungle setting and the camp’s feeling of community. There was a market, people laughing, flowers, goats, and colorful buildings. Our guide had a big grandfatherly smile. I could almost imagine the appeal of this peaceful community.

Unfortunately, the peaceful feeling came to an end as we approached the “sanitorium.”

Although warned about the use of chains, it was horrifying when I actually saw the inhumane methods used to restrain patients. In the small, bare building, there were ten men lying on the ground. Each man had a short chain on his leg that was bolted into the ground. The stench was suffocating, and a gutter ran across the room- it was the only bathroom the men had. One emaciated man (forced to fast) begged for help. Our guide explained the chain’s purposes: they ensured residents would not escape (many were forcefully brought to the camp by family) and they were a symbol: when you defeated the demon you would be freed of your chains.

Before leaving the camp, the director greeted us with a handshake and a smile, saying “God bless you.” The camp shocked me with its extreme contradictions. How could a place in such a gorgeous natural setting that seemed so peaceful and quiet employ such unimaginable tactics? This stark contrast is what made the prayer camp the most unsettling part of our trip to me.

China’s health care challenges, reforms and the role of leadership education

Martha Dale, Director, China programs, GHLI

How do the Chinese do it? This was a question that popped up when I spoke recently to the Silliman Fellows at their monthly seminar program. How do the Chinese manage to spend only $177 per capita on health care expenditures and accomplish such remarkable health outcomes? The average life expectancy in China is 73 years (compared to the U.S. at 78 years, World Bank 2009 data) and the United States’ annual per capita health care expenditure is a whopping $7,410? This, in a country of 1.33 billion people and an annual health expenditure of 4.6 % of the gross domestic product (GDP) – versus the US at 16.2% GDP?

That query got the assembled group thinking – what can we learn from our Chinese counterparts about getting the most from every health care dollar spent? Clearly, the intertwining of historical, social, political and economic factors have positioned China in 2012 with a unique health and health care system “portrait” and opportunities for improvement. But the U.S., likewise facing its own struggles in terms of health care financing, quality and access, may be able to take a page from the Chinese playbook.

China is regarded today as an upper middle-income country due to its rapid development trajectory over the past few decades. How impressive a thought that the US should be engaged with China in a dialogue about health policy and financing strategies. Where best to convene this dialogue? Yale Global Health Leadership Institute, where our China health care leadership programs reside, considers itself a center for debate and progress on leadership and other critical global health issues. Whether it be the GHLI annual conference held in New Haven each June, through research and education conducted with academic partners here in the US or abroad, or small, informal discussions like that with Silliman Fellows, dialogue and exchange are critical for discovering unexpected gems that will move the entire body of science forward. Let’s get talking!

Ethiopia prepares to launch hospital quality alliance to improve patient satisfaction

Zahirah McNatt,

GHLI Ethiopia Program Director

Building on GHLI’s work to improve hospital management and leadership capacity, more than 130 hospital executives, and representatives from the Federal Ministry of Health (FMOH), and partnering organizations recently met in Addis Ababa to discuss the design and launch of the Ethiopian Hospital Alliance for Quality (EHAQ). Minister of Health Tedros Adhanom Ghebreyesus joined the meeting to offer his support for the alliance, which is planned to launch in early 2012.

Ethiopia currently has 114 functional hospitals serving approximately 80 million citizens. The challenge to offer high quality, accessible hospital care to all of Ethiopia is daunting, but the EHAQ is an important step toward improved hospital management capacity across the country.

Seven years ago, GHLI joined FMOH and the Clinton Health Access Initiative to improve the quality of hospital care across the country. Since then, GHLI has trained more than 90 Ethiopian hospital CEOs through master’s programs in hospital and health care administration at Jimma and Addis Ababa Universities.

This past June, representatives from Ethiopia, including hospital CEOs and a representative from the FMOH, attended the annual GHLI conference at Yale, with the goal of developing a strategy to accelerate the scale-up of best practices in hospital quality improvement. Through their work, EHAQ was born.

Since the conference, the GHLI has been working with our colleagues to build high-level support for the alliance, and to develop a concrete implementation plan. It is envisioned that in the first year EHAQ member hospitals will commit to working on patient satisfaction. Several high performing facilities will be nominated as LEAD hospitals for the year and will be responsible for mentoring other facilities. All members of the alliance will receive detailed, evidence-based change packets to assist them with performance data analysis and action planning. The alliance will serve as a catalyst for this innovation and a platform for sharing of ideas across hospitals.

The alliance is not simply another new public health or development training project in Ethiopia; it is a clear statement that Ethiopian leaders are already creating innovative, Ethiopia-specific solutions to their health care delivery challenges. GHLI is pleased to be supporting Ethiopia on its path to high quality, patient centered care.

Why We Do What We Do: Marcella Nunez-Smith

Marcella Nunez-Smith, MD, MHS researcher at the Yale Global Health Leadership Institute, always knew that she was destined for medical school. However, global health was not always her goal. As a premed student at Swarthmore College, her introduction to global health began when she organized a group for students of Caribbean ancestry. “The organization was an opportunity to highlight the political, economic, and health challenges facing that part of the world,” said Marcella. “But, when I was an undergrad, the interdisciplinary field of global health was at its infancy and just not part of my world.”

However, Marcella watched – with great interest – the emergence and broadening of the global health field. With the expansion of global health, there were an increasing number of global health prospects overseas. “At the residency level, more mechanisms were put in place for people to travel internationally,” she explains. “I chose not to go abroad because I really felt very strongly that there were so many things that could be done domestically. Now more than ever, the lines between ‘domestic’ and ‘global’ are blurring.”

After completing a research fellowship at Yale, Marcella stayed on as a faculty member at the School of Medicine. It was her interest in health care equity that ultimately led her to GHLI, where she leads research on health equity and noncommunicable diseases in low- and medium-resource settings. Her research projects take place in the Caribbean, a region to which she is personally-connected, as well as in the U.S. Connecticut-based projects focus on discrimination in health care settings and she works on several national projects related to healthcare workforce diversity. Marcella’s work through GHLI emphasizes the importance of both domestic and overseas work. In her words, work in global health can mean “traveling two blocks to downtown New Haven or to Nepal.”

Shatreen Masshoor, Yale College, 2012