MassGeneral Hospital for Children (MGHfC) and its Division of Global Health is committed to providing MGHfC residents with outstanding training and mentorship during overseas clinical electives. Additionally, residents benefit from the expertise of a diverse faculty working in a multitude of international settings who are eager to serve as mentors to the next generation of leaders in pediatric global health.
Botswana is a land-locked middle-income country located in southern Africa, and bounded by South Africa to the south, Zambia to the north, Zimbabwe to the east and Namibia to the east. The population is slightly greater than 2 million people. Formerly a British Protectorate, in 1966 Botswana gained its independence from the British and has had a democratic and stable political system. In 1967, large quantities of diamonds were discovered. The gross domestic product of the country relies on the diamond and tourism sectors predominantly.
Botswana has the second highest prevalence of HIV among adults aged 15 to 49. This HIV-epidemic in Botswana led to support from the United States government in the form of the President’s Emergency Plan for AIDS Relief (PEPFAR) initiated by President Bush and with increased spending approved by President Obama. In late 1990’s, Professor Max Essex of Harvard School of Public Health met with President Fetus Mogae and formed the Botswana-Harvard AID Institute Partnership (BHP), a collaboration between the Botswana Government and Harvard School of Public Health to build laboratory capacity within the country to manage the HIV epidemic. This organization is one of the country’s national lab sites for HIV viral load testing. Activities have expanded to research and clinical education. In 2009, a partnership between BHP and Scottish Livingstone Hospital (SLH) was created to improve the overall quality of hospital care and provide a training site for Boston area residents. Scottish Livingstone is a district hospital with 350 beds and large outpatient services.
This clinical site accepts pediatric and med-peds residents to work on inpatient Pediatrics and Adult Medicine wards, the outpatient pediatric HIV clinic, and outpatient adult medicine, accident and emergency centers. There are opportunities to engage in a quality improvement project selected from a list of initiatives deemed to be important to the hospital’s management team. The contact person for this site is Dr. Kate Powis.
In 1994, at the height of an economic recession and after the signing of NAFTA, Chiapas was the site of an uprising of indigenous people, known as “Zapatistas” (named after Emiliano Zapata, who led a campesino revolt in the early 20th century). Direct hostilities between the Zapatistas and the government ceased after a few days and negotiations began. However, these have been stalled for years. Although clashes between armies have not occurred in recent years, Chiapas remains heavily militarized and tensions between the military and the Zapatistas are often high. Paramilitary violence has occurred at times in the northern highlands. Thousands of people (the majority indigenous) have been displaced. Poverty, lack of education, malnutrition, poor access to water, poor sanitation, and infectious diseases are widespread in the indigenous communities of Chiapas, Mexico. Militarization has rendered health service delivery and health monitoring problematic.
Chiapas has population of approximately 3.5 million inhabitants, and an estimated 30% are indigenous Indians, or Mayans. Chiapas has Mexico’s highest adult illiteracy rate; most crowded households; and lowest prevalence of access to running water. It has the highest infant mortality rate and death rate from gastrointestinal infections; malaria and TB are prevalent; and half of children under five are stunted. The municipality of Altamirano is located in southeastern Chiapas and is comprised of approximately 10,000 inhabitants, 80 percent of whom are Mayans.
Hospital San Carlos was founded in 1969 in Altamirano to serve the indigenous Mayans; Mexican nuns of the Daughters of Charity of St. Vincent de Paul run it. The hospital inpatient and outpatient services serve some of the poorest of the poor from >400 remote villages in the highlands. The community health program (run by Dr Juan Manuel Canales) plays a vital role in community health worker training, vaccinations, and other preventive health initiatives. Since 1998, Doctors for Global Health (DGH,www.dghonline.org) has worked with Hospital San Carlos and Dr. Canales to provide both hospital and community-based health care to the surrounding communities.
Pediatric and med-peds residents have an opportunity to provide clinical care on the inpatient wards and outpatient clinics; work with Dr. Juan Manuel Canales in the rural communities surrounding Altamirano training and mentoring community health promoters; and conduct QI projects in the hospital or public health projects in the communities, as prioritized by the hospital or community health workers. The contact person for this site is Dr. Jennifer Kasper.
With a population of 37 million, Uganda is one of Africa's largest and fastest-growing countries. Despite economic growth in the past decade, many Ugandans live in poverty and confront social and economic inequities: 65 percent of its population lives on less than US$2 per day. 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. Under the auspices of the MGH Center for Global Health, MGH has developed a multidisciplinary collaborative relationship with Mbarara University of Science and Technology (MUST) and Mbarara Regional Referral Hospital (MRRH), as well as with the health center at Bugoye, a level III rural health center serving 35,000 people located approximately three hours by car northwest of Mbarara. Residents from the MGH departments of medicine, surgery, OB-GYN, anesthesia, and other departments regularly visit MUST to collaborate on research and education. Additionally, the Bugoye Health Center is a primary training site for residents in the MGH Global Primary Care Program.
Faculty in the Department of Pediatrics at MRRH, in the MGH Center for Global Health, and in the Division of Global Health at MGHfC are engaged in research on malaria, TB, pneumonia, HIV, neonatal resuscitation, and other issues. A collaborative initiative is presently underway to develop a regional oncology center at MRRH, with support from the MGH Cancer Center and the Uganda National Cancer Institute.
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. 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. The contact person for this site is Dr. David Lyczowski.