The Mass General Critical Care Center’s Global Outreach and Health Initiative (GOHI) engages our global community to address health disparities for the critically ill and injured.
Embracing the Hospital’s 200-year legacy of leadership, Mass General Critical Care Center’s Global Outreach and Health Initiative (GOHI) seeks to deliver the best health care in a compassionate environment, to advance that care through innovative research and education, and to improve the health and well-being of the diverse communities we serve. Given the resource-intensive nature of care for the critically ill or injured, many agencies historically have been hesitant to invest in the necessary personnel, training, and infrastructure, especially in settings that are under-resourced. However, intensive care is essential to insure optimal outcomes wherever patients are severely ill, whether from trauma, surgery or infectious disease. Happily, recent technological advances in clinical care, education and research promise the transformative changes needed to provide modern, cost effective care even in extreme environments. GOHI provides the leadership for the MGH Critical Care Center to realize this vision.
A Collaborative Model
GOHI relies on a transdisciplinary model that integrates vertical interventions for disease with horizontal investments in health system strengthening, healthcare professional education, and holistic care of the patient. Our strategic approach has four core priorities:
- Investments in infrastructure
- Capacity building through clinical training and research mentorship
- Knowledge generation through research and scientific discovery
- Excellence and innovation in direct clinical care
GOHI works collaboratively with other clinical Departments at Mass General, including:
- Anesthesia, Critical Care and Pain Medicine
- Patient Care Services (Nursing, Respiratory, and Physical Therapy)
As well as the Mass General Center for Global Health. This GOHI collaborative model provides the synergy necessary to support our international partners in meeting their clinical and educational needs.
Investments In Infrastructure
Improvements in critical care outcomes cannot be achieved without improved infrastructure and access to equipment. Many facilities, including our partner sites, require additional bed-side monitors, ventilators, ultrasound and radiology equipment and expanded laboratory capability to provide contemporary intensive care for their patients. While donated equipment is frequently of use, older devices are sometimes difficult to repair, obsolete or come without a service plan. Over 90% of donated equipment will no longer be of use after 6 months. GOHI works to secure donations and grants to strengthen our partners infrastructure and technology. We ensure that the needed equipment is available with a service package that keeps the equipment reliable and safe. Finally, GOHI facilitates training for the new equipment and its use. As an example, the Department of Neurosurgery facilitated the donation and maintenance of an electric craniotomy drill from Stryker to the Mbarara University of Science and Technology.
Beyond clinics or medications, expansion of human resource capacity is essential for effective public health delivery in poor regions of the world. The WHO estimates that there are currently 57 countries facing critical shortages of health care workers and a total global deficit of some 2.4 million doctors, nurses, and midwives. Africa in particular bears 24% of the global burden of disease, carries only 3% of the global health workforce and commands less than 1% of world health expenditure. GOHI prioritizes these workforce and capacity building challenges and aims to train across the global burden of disease. GOHI targets capacity building for the full spectrum of health care professionals across the time continuum (pre-hospital to rehabilitation):
- Nurses essential to monitor and respond to patient needs with a family-centered orientation
- Physicians able to interpret and treat changes in clinical status
- Respiratory, Physical, and Occupational Therapists aimed at restoring vital organ function and fully re-animating those suffering from prolonged critical illness
- Clinical Pharmacists and Nutritionists who provide drugs and food tailored to prevent and/or treat disease
- Biomedical and Laboratory Technicians who maintain and staff devices for vital organ diagnostics, treatment, and support
Together with the Mass General Center for Global Health, GOHI supports a series of inter-institutional training and mentoring initiatives that provide an integrated approach to global health education with a timeline that spans generations. Training initiatives aim to support international exchange of doctors, nurses and health personnel to engage in global public health. Similarly, in-country physicians, researchers and other health science professionals collaborate with Mass General counterparts to participate in structured training programs in their respective home countries. Training opportunities span a variety of methods including:
- Direct clinical training in our partner sites
- Didactic lectures
- Teleconferences between Mass General and our partner sites
- Funding for trainees to attend conferences and meetings
Research and Discovery
The greatest burden of global disease lies in the poorest countries. However, efforts towards reducing global health disparities are handicapped by glaring disparities in global health leadership. While there are many promising leaders who have effectively championed local initiatives, the highest concentration of global health leadership still resides in regions with the lowest burden of disease, like the U.S. The majority of new public health knowledge originates in North America, Western Europe, Japan and Australia as compared to regions with the greatest burden of disease. In a recent evaluation of first-author publications using the keyword "HIV" over 50% of the first-authors came from North America and Europe; only 8% originated in sub-Saharan Africa where 75% of the global burden of HIV resides.
There is a paucity of publications on care of the critically ill and injured in resource-poor settings or extreme environments. Recent public health emergencies triggered by earthquakes, hurricanes and nuclear disasters have exposed the lack of infrastructure and capacity to perform clinical research in these settings. As a result, there is insufficient new knowledge gained with each disaster to ensure better responses for future challenges. GOHI partners with the U.S. Critical Illness and Injury Trails (USCIIT) Group and the International Forum for Acute Care Trialists (InFACT) to develop recommendations for clinical research and to foster investigator-initiated hypothesis-testing at a global level. One early deliverable is creation of regionalized information networks for emergency preparedness and study of care delivery and outcomes in resource-poor settings. Projects are designed to provide ample opportunities for education in clinical and translational research as well as a rich collaborative environment for mentorship of junior investigators and clinician scientists on both sides of the partnership.
Direct Clinical Care
Investments an infrastructure, building clinical capacity, and innovative research, are all aimed at improving clinical care and patient outcomes. When possible, this will include travel to provide hands-on clinical care at the bedside with our international partners. When bedside service is not physically possible, advanced telemedicine capabilities currently in development provide the opportunity for Mass General clinicians to directly supervise or participate in care of patients who are geographically remote. Our service includes treatment for common, imminently treatable diseases such as diarrhea, pneumonia and appendicitis, as well as those with advanced diseases, including heart failure, head trauma, and shock.
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