As part of its aim to reduce health disparities and achieve optimal health for children and adolescents in resource-limited settings of the developing world, the Division of Global Health at MassGeneral Hospital for Children focuses on a number of service delivery initiatives.
Addressing the needs of children in conflict and crisis Children are among the first and most severely impacted by the consequences of conflict and crisis. In fact, as a result of their inherent vulnerability, children are disproportionately impacted by war, social unrest, disaster, and economic crisis. Brett D. Nelson, MD, MPH, DTM&H, presently serves as the director of the Harvard Humanitarian Initiative’s program on Children in Crisis, which was established to specifically address the unmet needs of these hyper-vulnerable children by highlighting opportunities for improving the operational and policy response of service providers. Current projects include addressing the clinical and mental health needs of children and youth in crisis-affected regions of the Middle East and sub-Saharan Africa.
Training front-line providers in critical newborn and maternal care
The most dangerous moments in life are those around the time of birth. Newborn and maternal mortality are among the leading burdens of disease in resource-limited settings. Meanwhile, effective and simple interventions are available to prevent the vast majority of these perinatal/peripartum deaths. Antenatal care, facility-based deliveries, management of maternal complications, neonatal resuscitation, etc., are all cost effective. Nevertheless, these efforts have had limited reach in resource-limited settings, where the interventions are most needed. Over the last several years, Patricia Hibberd, MD, PhD; Archana Patel, MD; Brett D. Nelson, MD, MPH, DTM&H; Kristian Olson, MD, MPH, DTM&H; and others have been closely involved in building capacity among front-line birth attendants through training in many developing settings, including India, Liberia, South Sudan, Tanzania, Ghana, Indonesia, Cambodia, Kenya, Haiti, and Ethiopia.
Partnering with communities to provide health care and local capacity building in Mexico and El Salvador
While country-level health and economic indicators may give the impression that the populace is healthy, a closer examination of the communities where Doctors for Global Health (DGH) works reveals a stark reality. People live in extreme poverty (less than $1/day) in countries with some of the highest income disparities in the world. Their livelihood is negatively impacted by the social determinants of health; they have insufficient access to clean water, sanitation, sufficient food, and suitable housing. Access to appropriate, affordable and timely primary and subspecialty care is greatly lacking, and people suffer from high burdens of communicable and noncommunicable diseases. DGH’s mission is “to promote health and other human rights with those most in need by accompanying communities, while educating and inspiring others to action.” DGH practices “liberation medicine,” the conscious and conscientious use of health to promote human dignity and social justice. DGH currently has health, public health, community development, and local capacity-building projects (e.g. community health worker training) in partnership with communities in El Salvador, Guatemala, Uganda, and Chiapas, Mexico. Jennifer Kasper, MD, MPH, has been an active board member of DGH since 1996 and is the co-coordinator for DGH’s activities in El Salvador and Mexico (Please visit the Doctors for Global Health website at www.dghonline.org for more information.).
Pediatric care and education in a low-resource setting in Mbarara, Uganda
Sub-Saharan Africa faces a most daunting challenge: it bears 25 percent of the global burden of disease but has only 3 percent of the world’s health workers. Training and retention of professional health staff is a serious problem, and Uganda is no exception. At the Mbarara Regional Referral Hospital (MRRH), MGH pediatric residents have the opportunity to work alongside Ugandan pediatricians and trainees from the Mbarara University of Science and Technology (MUST) to provide inpatient and outpatient care and to develop educational initiatives in a low-resource setting. The MGH Center for Global Health has built a strong multidisciplinary and interdepartmental collaboration with MUST encompassing research, education, and clinical care, and MGH staff are always present in Mbarara. MGH pediatric faculty are currently active in research projects and medical education at MUST, and will provide close mentorship and support for the pediatric resident who choses to train at this site.