The past decade has witnessed a burgeoning interest in global health. The growing realization that tremendous disparities exist between health outcomes in high-resource and low-resource nations has driven education programs, research initiatives, program development, and tremendous growth in philanthropic funding. While disparities exist across the age spectrum, many of the most tragic ones begin at birth.
Peter P. Moschovis, MD, MPH
Division of Global Health, MassGeneral Hospital for Children
Peter P. Moschovis, MD, MPH; Division of Global Health, MassGeneral Hospital for Children
Global Health at Harvard Medical School and Massachusetts General Hospital
The past decade has witnessed a burgeoning interest in global health. The growing realization that tremendous disparities exist between health outcomes in high-resource and low-resource nations has driven education programs, research initiatives, program development, and tremendous growth in philanthropic funding. While disparities exist across the age spectrum, many of the most tragic ones begin at birth. Almost nine million children die annually before reaching their fifth birthday, and in sub-Saharan Africa, one in seven children die by age 5. Improving child health is clearly central to reducing global health inequities, and Millennium Development Goal #4 articulates the importance of addressing the diseases of childhood.
Dr. Moschovis and patient
The Harvard medical community has been at the forefront of research, program development, and education in global health. Global health programs, driven in many cases by faculty members’ own humanitarian service, have been created at all the major teaching hospitals affiliated with HMS. These programs have given rise to innovations in all three components of academic medicine – clinical service, education, and research.
Global health service has a long tradition at MGH and Harvard. Perhaps best known is Partners in Health, the organization started by BWH physician Paul Farmer, MD. Now active in health centers and hospitals across 11 countries, PIH is a model for an academic-NGO partnership. Within our own division, residents and staff have provided care both with PIH and many other NGOs and hospitals in diverse settings from Latin America to Haiti to sub-Saharan Africa and southeast Asia. Dr. Jennifer Kasper serves on the board of Doctors for Global Health, and has mentored medical students and residents seeking careers in global health. Clinical electives (with funding for travel) are available for MGHfC residents at various sites with MGH connections, including Mexico, Botswana, Liberia, and Uganda.
As the interest for global health service grew, it became apparent that service required specialized training in the diseases, methods, and unique challenges of global health delivery, prompting creation of education programs. Both BWH and MGH have special tracks within their internal medicine residency programs that train residents in global health, with longitudinal mentored experiences in global health sites accompanied by formal didactics and opportunities to pursue coursework at the Harvard School of Public Health. The goal of both of these tracks is to create “global health specialists” who will be leaders in global health delivery.
Our own pediatric residency program has developed a longitudinal elective in global health (LEiGH). Under the leadership of Dr. Michele Duke, the program includes three components:
Several course offerings are available through HMS and HSPH. Dr. Brett Nelson of MGH Pediatrics and Dr. Patrick Lee of MGH Medicine co-lead a course on “Clinical Topics in Global Health” for 3rd and 4th year medical students. The Harvard Humanitarian Initiative sponsors a training program for residents on humanitarian response, the Humanitarian Response Initiative for Residents (HSIR). This novel program, which includes a disaster simulation in Harold Parker State Forest, trains students in the science of humanitarian response, equipping students to respond to real-world disasters. The Global Health Delivery Project has created a summer curriculum on Global Health Effectiveness (offered this year from July 5-27) that includes coursework in epidemiology/biostatistics, management skills, and case studies in global health delivery.
Research in global health has traditionally focused on tropical diseases and the diseases of poverty, and several members of our department have made significant contributions to our understanding of the pathophysiology and treatment of these illnesses. Dr. Jason Harris’ work in cholera and enteric infections and Dr. Kate Powis’ work in HIV treatment have resulted in several high profile publications. The leading cause of death in young children worldwide is pneumonia, and Dr. Patricia Hibberd’s research in childhood pneumonia has set the standard for treatment regimens now recommended by the World Health Organization., Working with Dr. Hibberd, Dr. Peter Moschovis is studying environmental risk factors in childhood pneumonia and critical illness.
Many childhood deaths in developing countries come in the perinatal period, and the research of two MGH faculty members, Dr. Jonathan Spector and Dr. Kristian Olson, are focused on reducing neonatal deaths. Dr. Spector’s work focuses on neonatal resuscitation and safe deliveries; he is currently collaborating with Dr. Atul Gawande (BWH) on creating a checklist for safe deliveries. He also serves as the chair of the AAP Section on International Child Health. Dr. Kristian Olson’s research is in device innovation for safe deliveries and care of neonates; his work in designing a neonatal isolette out of Toyota car parts earned him a position in Scientific American’s Top 10 Leaders. Extending beyond delivery into the neonatal period, Dr. Miriam Haverkamp and Dr. Patricia Hibberd in the Division of Global Health are studying point-of-care diagnostics for neonatal sepsis.
As one of the most rapidly growing fields in pediatrics, global health presents unique opportunities in service, education, and research. MGHfC has taken on a leadership role in this important field, and the Division of Global Health welcomes collaborators from other divisions and across the Harvard medical community.
 Archer N, Moschovis PP, Le PV, Farmer P. Postearthquake Haiti renews the call for global health training in medical education. Acad Med. 2011 Jul;86(7):889-91.
 Chin CS et al. The origin of the Haitian cholera outbreak strain. N Engl J Med. 2011 Jan 6;364(1):33-42. Epub 2010 Dec 9.
 Shapiro RL et al. Antiretroviral regimens in pregnancy and breast-feeding in Botswana. N Engl J Med. 2010 Jun 17;362(24):2282-94.
 Addo-Yobo E et al. Oral amoxicillin versus injectable penicillin for severe pneumonia in children aged 3 to 59 months: a randomised multicentre equivalency study. Lancet. 2004 Sep 25-Oct 1;364(9440):1141-8.
 Asghar R et al, Severe Pneumonia Evaluation Antimicrobial Research Study Group. Chloramphenicol versus ampicillin plus gentamicin for community acquired very severe pneumonia among children aged 2-59 months in low resource settings: multicentre randomised controlled trial (SPEAR study). BMJ. 2008 Jan 12;336(7635):80-4. Epub 2008 Jan 8.
 Spector JM.. Inside Millennium Development Goal 4. Pediatrics. 2012 Apr 2. [Epub ahead of print]