You don’t speak Amharic?

Orit Abrahim, 2013 EHMI Intern

After 16 years away from Ethiopia, this was effectively my first visit to the country I insistently called my own. Until now my comprehension of the Ethiopian health care system consisted of horror stories carried across the Atlantic by family members seeking decent medical care. Misdiagnoses, missing providers, decrepit facilities, and questionable treatments had me believe it was only by sheer miracle that the population survived. I was sure then that my future skills would be best used where good health is only found through good luck.

Interning with the Ethiopian Hospital Management Initiative (EHMI) allowed me to see these fabled hospitals first hand. While the conditions did not immediately change my naïve perception, I did observe the influence on hospital administration by groups such as the Clinton Health Access Initiative and Yale GHLI. Hospital staff regularly record key performance indicators, Regional Health Bureaus and coordinators identify gaps to achieve Ethiopian Hospital Reform Implementation Guidelines, and measuring improvement is becoming common practice. I had the opportunity to participate in projects ranging from leadership and governance to labor and delivery clinical audits. My Harari (language spoken in Harar) skills were put to the test discussing improvements to the region’s referral system. Bottom-line: the country is ambitious and ready for reform.

Discussions with hospital staff and even family members made it more apparent to me the difficulties in expecting comprehensive care in a developing country. I learned that progress was the sum of several small efforts from several dedicated partners. Even though the road to success is slow and rocky (think Addis Ababa to Arbaminch), hospitals, the FMOH, and global supporters are willing to traverse dirt path after dirt path to reach their vision of quality care. For now it’s a matter of effectively connecting the country’s health system in this shared goal: putting the patient, the population, at the forefront of their priorities. Hopefully I’ll have the chance to return and continue my part in furthering health and well being in Ethiopia.

Addressing Chronic Disease in Trinidad

Monica Jordan, 2013 GHLI Fellow

Several weeks into my fellowship here in Trinidad, I’ve finally figured out how to navigate the bustling city of Port of Spain using taxis and public transportation. I recently moved from St. Augustine to Port of Spain, to begin work in the Ministry of Health as I switched focus from research support to implementation support.

The furthest southeast of the islands, and only seven miles from Venezuela at its closest point, Trinidad’s economy is driven by the petroleum industry, not tourism as I might have expected. A middle-income country, it is common for people to own cars, eat American-style fast food and spend leisure time in the malls. I was intrigued to learn that the large Kentucky Fried Chicken in Port of Spain has the highest amount of fried chicken sold out of any KFC branch worldwide.

While it is common knowledge in the public health community here that residents in Trinidad suffer from high levels of chronic diseases, the exact burden is unknown. The project I am working on will implement a pilot project of an electronic medical records system that will capture information on chronic disease, along with relevant risk factors including diet, physical activity, alcohol and tobacco use. 

What has really stood out to me in this process is the importance of early collaboration with all involved stakeholders. Trinidad’s de-centralized health system means that many directives are top-down.  In order for this proposed electronic system to work, there must be buy-in from the nurses and staff that will actually be working with it on a daily basis. While this collaboration can lend itself to a slower process in the planning for implementation, it holds greater potential for implementation and project success, and I am excited to be a part of that process throughout the remainder of my time here.

Updates from Ghana

Perri Kasen, 2013 GHLI Fellow

As my stay in Ghana continues, I can see how recent political and financial obstacles are impeding progress on operationalizing the 2012 Mental Health Bill. An ongoing Supreme Court case examining the legitimacy of President John Dramani Mahama’s administration continues to capture national attention. The trial is broadcast live on television, and it seems like everyone in Ghana is watching and engaging in political discussions about Ghana’s future as it relates to the court’s case and ruling. Though entirely fascinating for the political scientist nerd in me, the Supreme Court case has created huge roadblocks in implementing the Mental Health Bill, as many action items require Presidential approval.

While the larger policy has not been enacted, there are numerous projects operating on a smaller scale that give us reason to celebrate. By the end of the summer, the Ghana Health Service will integrate mental health indicators into their comprehensive health information system. This data will be utilized to gain a better understanding of the burden of mental disorders across Ghana, and to provide evidence to inform mental health policy decisions at the national, regional, and district levels.

After conducting a needs assessment the Psych Corps program, I identified numerous ways in which the program can be improved to ensure the greatest impact in local communities. Through speaking with current Psych Corps personnel, I gained a better grasp the immense challenges of delivering mental health care in communities where myths about “witchcraft,” harmful traditional healing practices, and stigma about seeing mental health care are woven deeply into the cultural fabric.

I am overwhelmed by the kind and gracious nature of the Ghanaian people. I’ve discovered a seamstress lives just across the street from my apartment and will be returning to New Haven with eight authentic Ghanaian dresses (!). With less than two weeks left in this vibrant country, I find myself already missing the delicious mangoes and the fantastic dancing.

Exploring Brazil’s ECD landscape

Mary Weng, 2013 GHLI Fellow

With a population of more than 11 million, São Paulo city could be classified as a small country. Working with public health on such a large scale is certainly daunting, but I am reminded that while there are great challenges, the potential benefits and gains are also great.

When I first started work on a strategy for early child development (ECD), I strived to seek out the perfect plan that would address the issue. My experience this summer has taught me that there is no “silver bullet” to address ECD in Brazil. During various site visits, I witnessed extremes in the range of quality and delivery of care. I visited the Dante Pazzanese Cardiology Institute, one of the premier pediatric cardiology centers in Latin America, and in contrast, then visited an Unidade Básica de Saúde (primary care unit) in a under resourced area of the city, where doctors sometimes see up to four patients an hour.

In a city as large as São Paulo, the vulnerabilities that children face are diverse. No single program or plan can address all of the issues; a set of strategies would be more adequate. At the same time, I have learned that the implementation process is just as important as the plan itself, and that the people working with the children must be equipped with the ability to handle the vulnerabilities they encounter.

I’ve met with NGO activists, child psychiatrists, nurses pioneering parenting programs, public health officials from the city of Sao Paulo – and I am inspired by the way everyone I have met does his or her job with such passion. The children of São Paulo have some great advocates on their side! As a result of my meetings thus far, I have been able to better map existing ECD programs and policies, and identify possible gaps that need to be addressed. With just a few weeks left in the country, I am picking up the pace to make sure I observe and contribute as much as I can before I leave.

Uganda NCDs Assessment

Hilary Rogers, 2013 GHLI Fellow

Someone told me watches in Uganda only have two options: sunrise and sunset. This, he said, leads to “Ugandan time,” the phenomenon of things happening late and running slowly. I have two reasons to argue his point: (1) my time here has flown by, and (2) our team has been able to get a considerable amount done since the conference.

My main project this month has been to develop a non-communicable disease needs assessment tool for the Ministry of Health (MoH). The MoH will use this tool in the regional referral hospitals, district hospitals and health centers. The information they gain from the tool will be integral to assess how to fill the gaps in NCDs personnel, provider skills, equipment, medicine, and more. While writing the needs assessment tool, I learned that equipment and medicine, even if deemed “essential” by the World Health Organization, may not work or may not even be available here. The MoH held a meeting about the tool with regional referral hospital managers and expert specialty physicians, and it was exciting to see these successful and intelligent people evaluate my work. Some of my other projects included confirming work on the start of the five-year plan of the delegation, shadowing doctors on NCD wards, and visiting another district for Uganda’s celebration of Sickle Cell Day (photo).

While discussing the assessment tool, one of my mentors commented that most of the research in Uganda focuses too much on the country’s problems and disease prevalence. Although this information is important, there should be more positive projects and innovations that have successfully worked. I am confident that this delegation’s work will fill this role, and their initiative will serve as model NCDs management for years to come.

With only two weeks left, I traded in my watch for a Ugandan watch, hoping to slow down and fully enjoy my time in this beautiful country.