This article originally appeared in the Summer 2015 issue of Brigham and Women's magazine.
Each year, millions of people around the world fall ill or die from preventable or treatable health conditions. In Africa—the world’s most populated continent with 1.2 billion people—the disparities are particularly acute. For example, more than 80 percent of patients in the U.S. survive certain cancers. In many African countries, cancer is almost always fatal. The United Nations reports that 34 of Africa’s 54 countries lack access to the most basic healthcare, from life-saving diagnoses to surgery.
Drawing on expertise in global healthcare delivery, medical training, and research, Brigham and Women’s Hospital (BWH) has deployed caregivers and trainees in nearly 20 African nations (see map), providing surgery, primary care, pediatric care, disease-specific care, women’s health services, and humanitarian emergency response.
To prepare the next generation of global health leaders and help build sustainable, high-quality healthcare systems throughout the African continent, BWH works with key collaborators Partners In Health (PIH), Harvard Medical School, and the Harvard T.H. Chan School of Public Health, as well as national governments and non-governmental organizations (NGOs). Here is a small sampling of global health initiatives in Africa.
Strengthening patient care
Lydia Pace, MD, MPH, an associate physician at BWH, served as a BWH Global Women’s Health Fellow from 2012 to 2014, caring for breast cancer patients in rural Rwanda—an environment with historically inadequate healthcare and resources.
“I learned about these patients’ significant delays in obtaining breast cancer care and the severe health impact those delays have,” says Pace, now the Mary Ann Tynan Fellow in Women’s Health at BWH. “I hope to help strengthen primary care in Rwanda and similar settings, which could play a key role in early breast cancer detection.”
In addition to bolstering primary care, BWH faculty and PIH have worked with the Rwandan Ministry of Health to open three district hospitals, most recently the Butaro Center for Excellence, the first site in Rwanda to focus on cancer care. And now BWH is helping to add pathology services to hospitals in Lesotho, Malawi, Nigeria, Rwanda, and beyond.
“Pathology is a crucial component of healthcare delivery,” says Dan Milner, MD, MSc, FCAP, associate medical director of microbiology at BWH. “Without it, subsequent surgical procedures, chemotherapy and radiation treatments are delayed or impossible. The numerous care centers we’re working with require different levels of help and capacitation. We do our best to meet these needs.”
Training tomorrow’s global health leaders
Another BWH global health program, the Doris and Howard Hiatt Residency in Global Health Equity, was launched in 2004 by Paul Farmer, MD, PhD, chief of the BWH Division of Global Health Equity, and Jim Kim, MD, PhD, now the president of the World Bank. Through this residency and numerous fellowships, BWH mentors and trains future physician-leaders for three years in Botswana, Lesotho, Rwanda, Uganda, and other countries, where they develop skills in global healthcare delivery, research, and health policy development.
Saving lives by improving services
Just as BWH’s global healthcare and training programs strive to close the gaps in expertise across the African continent, research projects aim to create simple, low-cost medical solutions. One such innovation is Lifebox Foundation, co-founded and led by BWH surgeon and Ariadne Labs Executive Director Atul Gawande, MD, MPH, and supported by a generous gift from donors Howard and Michele Kessler.
Lifebox teaches safer surgical practice and to date has delivered more than 4,500 pulse oximeters—essential monitoring devices that curb anesthesia deaths in the operating room—to hospitals and clinics in 38 African countries. More than 5 million people have already benefited from Lifebox’s safer surgery and anesthesia program.
“The volume of surgery done globally now exceeds the volume of childbirths, but with death rates 10 to 100 times higher, particularly in lower-income regions of the world,” says Gawande. “Through our equipment and training programs, we help local caregivers lead their communities to long-term safer surgery. Lifebox is the only NGO working specifically to address this problem at a large scale.”
Collaborating to make a world of difference
Rwanda is a leading example of healthcare transformation through collaboration. Since 2005, BWH and PIH have worked with the Rwandan Ministry of Health to build healthcare facilities and training programs, and to develop rural care delivery models that can be replicated throughout Rwanda and other African countries.
Collaborations with BWH’s donors also drive improvements in global health. On a trip to Rwanda, philanthropist Dan Ponton learned firsthand how the housing shortage in Butaro made it difficult to attract and retain qualified medical staff at the new hospital. The Daniel E. Ponton Fund at Brigham and Women’s Hospital subsequently funded construction of four duplexes to house as many as eight doctors at Butaro Hospital. Additional building is underway.
All told, healthcare gains for the Rwandan people have resulted in a doubling of the life expectancy since the 1994 genocide, which left it as one of the world’s poorest and sickest nations. Together, BWH clinicians, researchers, and donors hope to fuel similar improvements elsewhere across the African continent.
“What makes global health work successful is partnership,” BWH President Betsy Nabel, MD, says. “The ability to connect and work together is essential.”