MassGeneral Hospital for Children News

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

23/Apr/2012

Peter P. Moschovis, MD, MPH

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

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.[1]  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:

  • Global Health Day, a one-day course each fall designed to teach residents about the global burden of disease, child nutrition, newborn and maternal-child health, and infectious diseases.  This course is open to pediatric and med-peds residents in any year of training, and is designed to teach residents the essentials of “what you need to know before you go” on an international elective.  The next Global Health Day will be offered on September 22, 2012.
  • Global Health Enrichment Events, evening sessions that provide residents and faculty an opportunity for informal mentorship and teaching on specific diseases, careers in international health, cultural professionalism, and post-travel experiences.  These Enrichment Events are held on a monthly basis, kicking off with a ‘welcome evening’in August 2012.
  • A protocol for international rotations, through the residency Wikidot website, allowing residents to navigate through the various options to select sites that are safe, mentored, and educational.  This also includes an opportunity to debrief after an international experience.

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.[2]  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.[3]  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.[4] 

Nursery

 

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[5] and Dr. Kate Powis’ work in HIV treatment[6] 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.[7],[8]  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;[9] 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.[10]  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.


[1] 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.

[2] http://ghsm.hms.harvard.edu/uploads/pdf/clinical_topics_global_health_201011.pdf

[3] http://hhi.harvard.edu/student-resources/humanitarian-studies-initiative

[4] http://globalhealthdelivery.org/ghd-academic-offerings/harvard-global-health-effectiveness-program/

[5] 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.

[6] Shapiro RL et al.  Antiretroviral regimens in pregnancy and breast-feeding in Botswana.  N Engl J Med. 2010 Jun 17;362(24):2282-94.

[7] 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.

[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.

[9] Spector JM..  Inside Millennium Development Goal 4.  Pediatrics. 2012 Apr 2. [Epub ahead of print]

[10] http://www.cimit.org/news/scientific-american-honor-roll.html

The Research Council at MassGeneral Hospital for Children

Learn how the Research Council supports and enhances research within MassGeneral Hospital for Children as well as new initiatives and directions for pediatric research at Mass General.