U.S. Counties Winning the War on Obesity

Patrick Ng, 2014 GHLI Fellow

This summer I had the exceptional opportunity to help investigate the obesity epidemic in the U.S. I traveled with GHLI researchers across the country to five counties that, in spite of their socioeconomic profiles, which were associated with higher rates of obesity, were faring astonishingly well with rates among the lowest in the country. We termed these counties “positive deviants” – or counties that were statistical role models – and hypothesized that the strategies by which these counties marketed, integrated, and sustained programs for healthy living were making the difference.

Our team gathered data by interviewing local community leaders to pinpoint factors that would foster an environment conducive to healthy living. Though each location was unique –some characterized by arid deserts and others by lush hills–we could not help but notice striking similarities across the counties. 

We observed the importance of having open-minded, persistent, and empowering leaders in the fight against obesity – from school nurses to master gardeners to non-profit organizers – who worked tenaciously to see their families and friends thrive. These champions set an example for their colleagues who also responded with self-drive.

Community pride ran deep: both young and old showed their dedication through strong involvement in volunteering and through honest dialogue. Many of these counties showed exceptional openness to modern standards for “healthy living,” some times even at odds with local traditions. This cultural resilience and flexibility seems to have made these counties particularly nimble in combatting obesity – a very social disease. 

Our interviews have suggested that a proactive, supportive environment is needed to transform awareness about obesity into action and, ultimately, long-term change.

Making Babies Breathing Affordable

Charles Stone, ‘ 14, GHLI Intern

Each year, an estimated three million babies die during the first four weeks of life around the world. More than 50% of these deaths are attributed to birth asphyxia, respiratory insufficiency and complications stemming from preterm birth.  Devices to help prevent some of these deaths – such as the Humidified High Flow Nasal Cannula (HHFNC), which costs $5,000, are prohibitively expensive for low resource settings.

As interns at the Yale Global Health Leadership Institute, undergraduate engineers Katy Chan '15, Jordan Sabin '16 and myself (Team PremieBreathe), made encouraging strides to address this issue. Building on a design I developed for my senior project, our goal was to fabricate a functional, low-cost prototype of the HHNFNC. 

Every day presented new challenges as we grappled with tricky physics concepts. We spent hours theorizing and testing (and re-testing) how best to control the vapor pressure of traveling air at varying temperatures.   Perhaps the most insightful part of the project involved understanding how our prototype would behave when in contact with a baby.  For this we had to be quite creative.  We rolled up heating pads to resemble the size of a premature infant and “dressed” the bundle in Jordan's finest set of baby clothes.  From this we learned that this thermal contact with the nasal cannula significantly reduced condensation in the system. We celebrated that small milestone over tasty hamburgers at Louis' Lunch (home of the original hamburger!). 

By the end of this summer, we demonstrated that our prototype closely mimicked the commercial device -- for the modest price of $340. It delivers a customizable flow of humidified and warmed air, through a standardized nasal cannula that feeds into a baby’s nostrils.

We are excited to continue project with the ultimate of goal of visiting Ethiopia to better adapt the device for use in the developing country context. To learn more about our project, visit https://premiebreathe.wordpress.com/

Building Capacity for Mental Health Care in Ghana

Austin Jaspers, 2014 GHLI Fellow

Even before my time in Accra as a GHLI fellow reached its endpoint, I started plotting ways I could return and continue Yale’s long-standing partnership with Ghana in the area of mental health. This summer, I contributed as a member of a team dedicated to improving community-based mental health care in Ghana. Stakeholders and experts hailing from both sides of the Atlantic exchanged big ideas, new concepts and countless drafts as we moved forward in designing a new training program for the Psych Corps.

I learned about lay counseling and mental health care from the standpoint of a practitioner while simultaneously supporting the high-level operations of the Ghana Psych Corps.  As part of the National Service scheme, the program faces the unique challenge of refreshing its entire workforce on a yearly basis while attempting to build upon collective experiences.

In collaboration with faculty at Yale to gather data from community mental health workers and conducted qualitative interviews which enabled us to understand the Psych Corps’ role in the broader health system and identify opportunities to improve the program. 

I worked with colleagues in Ghana to build a sustainable and effective supervisory structure for Psych Corps. This improved framework will be part of the training toolkit we will present with our colleagues from Ghana at the GHLI Forum for Change in Accra this fall.

With the Psych Corps serving on the frontlines, I am optimistic that Ghana will steadily grow its capacity to deliver mental health services in the coming years.

Leaving Trinidad with Much More than a Side ah (sada) Roti

Ffyona Patel, 2014 GHLI Fellow

As I reflect on my fellowship with Trinidad’s South-West Regional Health Authority (SWRHA), I am energized by what we have achieved and what I am taking away. When I arrived, it became clear to me that the idea to pilot test a health information system (HIS) around non-communicable diseases (NCDs) had long been birthed but not quite developed. Toward this progress, stakeholder awareness around the idea, its roots and its benefits needed to be established and the project steering committee’s foundation, objectives, and next steps needed to be solidified.  

In the weeks that followed, I delivered project briefings to different SWRHA stakeholder groups, allowing them to learn about and engage directly with the project. Audience members shared ideas on how to develop a sustainable HIS to facilitate treatment and prevention of NCDs based on their unique roles.  

I also helped establish and routinize the steering committee’s action-oriented meetings – ground work which will hopefully create project champions among committee members and lead to a comprehensive pilot project. 

I learned that communicating information across stakeholders can empower.  This empowerment can translate into knowledge sharing and on-the-ground commitment toward project success; this has proven true for SWRHA’s vast system where stakeholders may have felt that system-level changes affected them but could not be affected by them. 

Thank you, SWRHA, for your hospitality. You demonstrate that health care leadership happens every day across many supportive, administrative, clinical, and managerial staff that work to provide quality patient care. I look forward to seeing your flourishing HIS for NCDs come to life and set precedent for T&T as a whole.

Obesity and Healthy Living Across the US

Source: http://prafulla.net/life-style/america-land-of-the-obese-infographic

Lea Hamner, 2014 GHLI Fellow

Over the past few months, I have travelled to five counties across the US to better understand why certain regions in a state have lower obesity rates than similar counties in the rest of their state.  I work with a team of GHLI researchers who seek common themes across these counties in order to examine what may be replicated elsewhere to foster a community of health and reduce obesity rates. Some of these counties seem like an obvious pick to me—an urban setting, a progressive culture, an abundance of outdoor activities. Yet, we also encountered some tiny rural counties in the middle of nowhere that somehow seem to be doing things right.

One of our visits was to a county with a total population of about 25,000. We stayed in the one hotel in town at the center which was about a mile stretch of road. Everyone not only knew each other – but it was quickly evident that they genuinely cared about each other. We conducted 10 interviews asking participants why they thought this town was able to keep obesity rates down. Each interviewee was remarkably candid and excited about the work being done. Within an hour of our individual chats, we had a comprehensive understanding of the county—as well as a group of new friends who welcomed us into their community. They were so inviting that we were welcomed to pick green beans with one interviewee in her intentional-living community. The chipper attitude, hope, and resiliency of these individuals were palpable. This success and progress was not what I expected but I will happily admit that this county had fostered an incredible culture.

Addressing Violence in Early Childhood to Improve Global Health

Mike Skonieczny, GHLI Executive Director

From left to right: GHLI Executive Director Mike Skonieczny,
First Lady Ana Estela Haddad,
and James Leckman, MD of the Child Study Center

Childhood violence and global health – two seemingly disparate issues that may be more closely related than one might think. As part of the Yale Global Health Leadership Institute Forums for Change program, we worked with colleagues at the Yale Child Study Center and in Brazil to discuss early childhood development (ECD) issues, including the effect of violence on children. 

Comprised of academics, clinicians, policymakers and advocates, our Brazilian delegation recently visited Yale with the goal of continuing to develop effective ECD programs for the children of São Paulo. The group discussed how the welfare of children and families is about more than just physical health, and why emotional and mental well-being are also critical components. But what does violence have to do with global health? 

Research by the World Bank has proven that children who participate in well-conceived ECD programs tend to be more successful in school and are more competent socially and emotionally. The early years are also critical in the formation of cultural norms, identities and prejudices in terms of a child’s behavior towards others.

In 1996, the World Health Assembly declared violence a major public health issue. This signaled an urgent need to reduce the toll of day-to-day violence and finding effective ways of preventing larger conflict. Peace-building efforts have generally involved top-down approaches, but peace is more than just the absence of physical conflict – it is a multi-dimensional process of investing in social, economic and political structures and policies that minimize violence in all of its forms.

Given this wider scope, early childhood development issues have gained unique significance. ECD programs present an untapped opportunity for empowering young children with the values, attitudes and skills that contribute to the reduction of violence in their communities. There is an enormous opportunity for ECD programs to build safer and healthier families, communities and, potentially, nations.

Helping the Smallest in One of the Biggest Countries in the World

Carolina Rivera, 2014 GHLI Fellow

The fifth most populous country in the world, and fourth largest economy with burgeoning growth, Brazil still faces serious struggles involving wealth disparity, poverty and violence. There also exists a wealth of knowledge, passion and solidarity that have helped the country achieve universal health care and allowed it to make substantial strides in the field of early childhood development.

I’m currently in Brazil working as part of the GHLI Forums for Change. Compared to the 11 million São Paulo city residents, 43 million São Paulo state residents and more than 200 million residents of Brazil, our delegation of 10 leaders may appear minuscule, but is large in spirit. 

During my time in this beautiful country, I already met the Minister of Health, Arthur Chioro, who is in charge of administration and oversight of the “Unified Health Care System” for all of Brazil. The Minister signed into action the allocation of millions of dollars to public hospitals in São Paulo for the healthcare of expectant mothers and children.

Through multiple site visits to work places, universities and hospitals, I help identify critical points of contact and opportunities for meaningful collaboration. Despite their different backgrounds, from government officials to academics and the third sector, all acknowledge the importance of communication and partnership in moving forward with efforts to improve early childhood development in São Paulo and Brazil.

As I continue my work here, I’m excited to establish and solidify more ways that our Brazilian delegates can work together, share information, and expand both our group and potential impact. Great, complex and ever-growing, São Paulo, Brazil is fortunate to have these visionary leaders working to improve early childhood development opportunities for all.

Weebale (thank you) and weeraba (goodbye)!

Sarah Ali, 2014 GHLI Fellow 

On my last day of work in Uganda, my supervisor commented, “I have not seen you like this. You are not smiling.” After more than two months in Kampala, I was just not ready to leave. I found the Ugandan culture fascinating and grew close with the many people who welcomed me to the country, opened their homes and shared with me their traditions. I witnessed tremendous compassion in Ugandan daily life and was moved to see it also reflected in the practitioner-patient relationships. 

The Uganda Initiative for the Integrated Management of Non-Communicable Diseases (UINCD) aims to develop a Center for Excellence for non-communicable diseases (NCD). This requires both a pilot study to audit practitioners’ recognition and management of NCD in the Mulago Hospital and a pilot clinic to implement an integrated NCD management clinic in the existing medical outpatient clinics which typically treat hypertension, diabetes and renal diseases on designated days. 

During my visits to the medical outpatient clinics, I was struck by how doctors treat more than the patient’s physical issues, but also listen to patient stories about the socioeconomic factors influencing their health. When I described the UINCD project to different practitioners, I was met with enthusiasm for the project and insight into potential hurdles such as inadequate training, missing and poorly maintained equipment and frequent health care worker movement throughout the hospital. Despite concerns, practitioners were encouraging about the project and excited to be involved. The compassion of the many workers I met made me all the more inspired by this project and confident that I’m really only saying goodbye for now. 

Obstinate Optimism—on the road to prosperity and meaning in Rwanda

Sanjeev Kumar, Assistant Professor of Health Management at the University of Rwanda School of Public Health

I recently had the opportunity to go to Rwanda and teach a short course on health economics to the Master in Healthcare and Hospital Administration program at the University of Rwanda School of Public Health. It was my first trip to Africa, and I was eager to observe and grapple with the central challenges facing a growing economy. I entered Rwanda full of excitement with a smattering of anxiety stemming from the uncertainty of new surroundings. I left Rwanda with an intense yearning to return, inspired by the enormous possibilities for growth and the dedication and the openness of the population there to make these possibilities real. 

The change in my attitude was fostered by the obstinate optimism in the air of Rwanda: From the local commitment to the built environment, to the unusual discipline and dedication of the GHLI team strengthening and building Rwandan health sector, my experience rekindled my desire to provide people with the tools to improve the public health in their communities. My conversations with the faculty and students filled me with hope and enthusiasm to help find ways to combat poverty and disease. I had a tremendous time enjoying the local fruits and foods, engaging with the local culture and experiencing Rwanda’s enchanting natural beauty. Because my description can’t do it justice, I would encourage any reader with a sense of adventure to see it for themselves. As recent events have shown us and my experience has reminded me, we are all connected for better or for worse—I think for better.