Global Health

The Division of Global Health (DGH) at MassGeneral Hospital for Children includes energetic faculty members and senior research fellows. The Division's primary mission is to build and foster international partnerships for interdisciplinary research, education and service to reduce health disparities and achieve optimal health for children and adolescents in resource-limited settings of the developing world. Our multidisciplinary team of faculty has significant experience working in the global arena, and in mentoring and teaching future leaders in global health.

Overview

Letter from the Chief

The Division of Global Health at MassGeneral Hospital for Children was founded in 2010 and includes faculty, research fellows and staff with diverse experience and interests but a shared objective. Our goal is to build and foster strong partnerships for interdisciplinary research, education and clinical care aimed at improving the health of the most vulnerable children in our global community.  Our work builds not only upon MassGeneral Hospital for Children’s long-standing commitment to scientific and clinical innovation, but also on our strong desire to see every child reach their full potential.

Our teams work on the most important challenges in pediatric global health. We focus on:

  1. Conducting world-class research that improves the availability of evidence-based healthcare for children, finding answers to important questions which are needed to shape health policies.
  2. Helping to train global health clinicians through educational opportunities and collaboration
  3. Building multifaceted international partnerships that foster sustainable action and impact

Our faculty and staff work on innovative solutions to prematurity, birth asphyxia, neonatal sepsis, childhood pneumonia, cholera transmission, and HIV at several sites across the globe.  Each day, we strive to apply the strengths of the Mass General community to help the most vulnerable children in our global community.

Sincerely,

Jason B. Harris, MD, MPH
Division Chief, Pediatric Global Health
Associate Professor of Pediatrics
Harvard Medical School
Pediatric Infectious Diseases, Microbiology

Group Members

Core Faculty

Jason Harris, MD, MPH

Dr. Harris is a pediatric infectious disease specialist with an interest in host-pathogen interactions in bacterial enteric infections.  He received his M.D. from Duke University and M.P.H. from the Harvard School of Public Health. He was a pediatric resident and chief resident at the Massachusetts General Hospital and was a pediatric infectious disease fellow at Boston Children's Hospital.  To better understand the human immune response to cholera and enteric fever, our group has been working in collaboration with investigators at the International Centre for Diarrhoeal Disease Research in Dhaka, Bangladesh (since 2003) and in collaboration with investigators at Partners In Health in Haiti (since 2010). 


Jennifer Kasper, MD, MPH

Jennifer Kasper, MD, MPH

Dr. Kasper is an attending pediatrician at MassGeneral Hospital for Children, Instructor at Harvard Medical School and Board Member of Doctors for Global Health. Her diverse global health expertise includes health service delivery; rural community development; complex humanitarian emergencies; field-based operations research; health system strengthening; and curriculum development, training and mentorship of community health workers and other health professionals. She has worked in numerous countries, including El Salvador, Mexico, Haiti, India, Mozambique and South Africa. She received a combined BA/MD with honors from Boston University/Boston University School of Medicine and an MPH from Boston University School of Public Health. Dr. Kasper works clinically at the MGH Chelsea HealthCare Center; co-directs “The Introduction to Social Medicine and Global Health” at Harvard Medical School; and is the Chair of the HMS Faculty Advisory Committee on Global Health. She was the recipient of the HMS/HSDM Deans’ Community Service Lifetime Achievement Award for her nearly two decades work with Doctors for Global Health. She was also a nominee for the HMS Donald O’Hara Faculty Prize for Excellence in Teaching. She is a co-editor of the MGHfC Handbook of Pediatric Global Health.


Ann Kao, MD, MPH, DTM&H

Ann Kao, MD, MPH, DTM&H

Dr. Kao is currently the co-director of the Pediatric Hospitalist Division at MassGeneral Hospital for Children, and she attends on both the Adult Internal Medicine and Pediatric services at Massachusetts General Hospital. She has previously worked on various projects, most recently in Ecuador as part of an effort to increase services to developmentally disabled children. She has also led a team in a healthcare project for children in Panama supporting a local NGO, Pro Ninez. In 2005, she worked on behalf of the Tsunami Relief effort as part of Project Hope. Dr. Kao was also a Mass General Durant Fellow in Refugee Medicine traveling to Rwanda, where she started up a health center and hospital in a refugee camp working with American Refugee Committee and UNHCR in 2007-2008. She has also worked in Romania and Vietnam, and she was a pediatric clinical advisor to the Cambodian Health Committee. Domestically, Dr. Kao has worked at a Navajo Reservation in Chinle, AZ, and an urgent care clinic in Chelsea, MA, serving a population largely consisting of immigrants from Latin America. She received the University of Washington School of Medicine Alumni Humanitarian award in 2007. Dr. Kao received her medical degree with honors from the University of Washington, and completed her combined residency in internal medicine and pediatrics at Massachusetts General Hospital, MassGeneral Hospital for Children and Children’s Hospital Boston. She received an MPH from the Harvard School of Public Health 


Peter Moschovis, MD, MPH

Peter Moschovis, MD, MPH

Dr. Moschovis graduated from the University of Chicago Pritzker School of Medicine and trained in Internal Medicine/Pediatrics at Massachusetts General Hospital.  He completed clinical training in pulmonary and critical care medicine in the Harvard Combined Pulmonary/Critical Care Fellowship, and is currently a global health research fellow in the Division of Global Health under the mentorship of Dr. Patricia Hibberd.  Dr. Moschovis’ global health research focuses on treatable risk factors for childhood pneumonia and adult chronic respiratory disease.  Together with collaborators in Uganda, he is principal investigator for a study of risk factors for poor outcomes in childhood pneumonia.  He is also involved in a training initiative for pulmonary medicine in Uganda.


Brett D. Nelson, MD,   MPH, DTM&H

Brett D. Nelson, MD, MPH, DTM&H

Dr. Nelson is an attending pediatrician and global health faculty at MassGeneral Hospital for Children and an Assistant Professor at Harvard Medical School. His professional interests are health care provision, development, research, and advocacy for vulnerable populations, particularly newborns and children in settings affected by poverty, conflict, or disaster. He helped establish the nation’s first Pediatric Global Health Fellowship at Massachusetts General Hospital and was its first fellow. Dr. Nelson has advanced degrees in public health (Johns Hopkins) and tropical medicine (London School of Hygiene and Tropical Medicine). He has been involved in pediatric care, academic research, program management, and global health consultancy in dozens of resource-limited areas while working for organizations, such as the Centers for Disease Control, International Rescue Committee, International Red Cross and Red Crescent, UNICEF, Médecins Sans Frontières, Johns Hopkins, and Harvard University. Recently in Liberia, Dr. Nelson served as country’s Senior Pediatrician and as the Interim Chair of the Department of Pediatrics and Newborn Medicine for the country's sole teaching hospital. He currently leads newborn and child health programs in several countries in East and West Africa. Dr. Nelson works clinically as a newborn hospitalist, and he co-directs a course at Harvard Medical School on tropical diseases and global health. He is the Editor of the new Wiley-Blackwell medical textbook, Essential Clinical Global Health.


Kate Powis, MD, MPH, MBA
Kate Powis, MD, MPH, MBA

Dr. Powis graduated from Medical College of Virginia and completed a combined Internal Medicine – Pediatrics Residency Program at Massachusetts General Hospital and Boston Children’s Hospital. During residency she worked with the International Organization of Migration to rehabilitate the primary health care system in the Province of Aceh, Indonesia following the devastating earthquake and tsunami of 2004. This project, conducted in coordination with the Indonesian Ministry of Health and local health authorities, led to a second focused project addressing the high maternal and neonatal mortality rate in the Province. After residency, Dr. Powis completed a Global Women’s Health Fellowship through the Connors Center for Women’s Health and Gender Biology at Brigham and Women’s Hospital. During her fellowship, she obtained her MPH at Harvard School of Public Health.  Since 2008, Dr Powis has Botswana with Botswana Harvard AIDS Institute Partnership, spending six months out of each calendar year in Botswana.  She focused on research projects primarily involving HIV-infected women, pregnancy, pregnancy outcomes and the health of children born to HIV-infected mothers.  Recently, she served as the Principal Investigator on a CDC funded study, carried out in collaboration with Botswana Ministry of Health to investigate the determinants of malnutrition in children under the age of 5.  When she is in Boston, she attends on the Adult Inpatient Medicine Service, Pediatrics and MGH Chelsea Urgent Care.


Kevin Schwartz, MD

Dr. Schwartz is a Pediatric Hospitalist and Pediatric Emergency Medicine faculty member at MassGeneral Hospital for Children.  He attended the University of Massachusetts Medical School, completed his Pediatric Residency at MassGeneral Hospital for Children, completed a Pediatric Emergency Medicine Fellowship at Boston Medical Center and completed one year of clinical training in Pediatric Hematology/Oncology at Hasbro Children's Hospital before returning to MGHfC.  Dr. Schwartz is co-founder and US Executive Director of The Child is Innocent, a non-governmental organization that provides educational opportunities and leadership development training to children from Northern Uganda.  During his Emergency Medicine fellowship, he conducted research in innovative curricula to prepare US pediatric and emergency medicine residents for clinical work abroad.  He has worked in Liberia to expand pediatric medical student and resident education in collaboration with pediatric faculty there.  His current research interests include medical education in global health and the acute management of tropical disease and the adaptation of pediatric oncology treatment protocols to low and middle-income health care settings.

Research Projects

Reducing Asphyxia-Related Perinatal Mortality in Resource-Limited Settings

Brett D. Nelson, MD, MPH, DTM&H, and collaborators are committed to addressing the leading causes of mortality during the most dangerous time in life: the few moments around birth. Each year, nearly 3 million newborn deaths and 3 million stillbirths occur worldwide. The vast majority of these perinatal deaths occurs in low- and middle-income countries and are most commonly a result of asphyxia (intrapartum-related complications), infection, prematurity and birth complications. Nearly all of these deaths are preventable. However, there has been limited success in implementing proven interventions in resource-limited settings. A critical next step in reducing millions of annual perinatal deaths is assessing barriers to the successful introduction and sustainability of proven interventions. With this aim in mind, Dr. Nelson is currently leading the critical evaluation of country-level newborn training programs in East and West Africa.

Analysis of the Effects of In-Utero Antiretroviral Exposure on Longitudinal Growth of HIV-Exposed Uninfected Infants in Botswana

Kate Powis, MD, MPH, MBA, is an investigator in two NIH-funded Botswana-based randomized controlled trials which investigated mother-to-child transmission (MTCT) of HIV. She is using data collected in the Mashi and Mma Bana studies to evaluate any difference in growth patterns over the first 24 months of life for HIV-exposed uninfected infants born to HIV-infected women who either took three antiretroviral drugs or zidovudine during pregnancy for prevention of MTCT.

Research on the Issues Surrounding HIV-Infected Pregnant Women and Their Infants:

Kate Powis, MD, MPH, MBA, is a co-investigator in two NIH-funded Botswana-based randomized controlled trials (RCT):

  • The Mpepu study initiated enrollment in May 2011 and with over 2,500 HIV-infected women and their HIV-uninfected infants enrolled thus far and total planned accrual of approximately 3,700 mother-infant pairs. Infants will be randomized to daily cotrimoxazole (CTX) or placebo from as early as 14 days of life through 15 months of life. For mothers opting to breastfeed, infants will be randomized to 6 or 12 months of breastfeeding. Infant HIV-free survival will be analyzed at 18 months of life based upon randomization to CTX or placebo. Additionally, 2010 revised World Health Organization guidelines recommending 12 months of breastfeeding in resource-limited settings, the Mpepu study will be the first randomized controlled trial to provide evidence-based outcomes of HIV-transmission rates and HIV-free survival outcomes comparing 6 months to 12 months of breastfeeding.
  • Early Infant Treatment: HIV-exposed infants born in selected hospitals in Botswana will undergo HIV testing on day of birth.  Any infants found to be HIV-infected will be initiated on treatment within 24 hours of a positive result and followed through at least two years of life.  This study will establish PK levels of antiretroviral drugs in the first weeks of life in order to devise safe dosing guidelines and will explore whether or not early initiation of antiretroviral treatment in HIV-infected infants prevents the establishment of viral reservoirs.

Determinants of Malnutrition in Botswana among Children under the Age of 5

  • This cross sectional study enrolled infants and children under the age of 5 attending well-child visits at government health facilities in Botswana, along with their caregivers in 2013 and 2014.  Over 1,600 child-caregiver pairs were enrolled in the study.  Anthropometric measures were obtained from the infant/child, their health records were abstracted and socio-demographic information was solicited from their caregiver.  This study represents a collaboration between Botswana Harvard AIDS Institute Partnership, Botswana Ministry of Health and Massachusetts General Hospital. Results of the study are being used by Botswana Ministry of Health to alter national healthcare and nutrition policies.  The dataset from the study is available to interested residents for smaller research projects/publications.  Interested residents should contact Kate Powis at kpowis@mgh.harvard.edu.

Evaluating the prevalence and causes of anemia amongst females in India using needleless technology

Nupur Gupta MD, MPH

Anemia is a major contributor to maternal and child death. It is a preventable cause of mortality and morbidity, yet it continues to affect a third of the world’s population and causes 68 million disability adjusted life years (DALYS). The prevalence of anemia in India is staggering, with estimates suggesting that 88% of pregnant women, 55% of non-pregnant women, and 70% of children under-5 are affected. Iron-deficiency anemia increases risk of preterm labor and low birth rate, child and maternal mortality; negatively impacts the cognitive development and physical growth of children, and weakens both the mother and child's immune response to infection. Amongst adolescent girls, physical growth and menses can aggravate anemia and place young girls at risk for complications and mortality during their pregnancy. Anemia during pregnancy can contribute to maternal death by exacerbating hemorrhage, septicemia, eclampsia, and cardiac arrest. In India although anemia has long been recognized as a problem four decades of efforts have failed to make a significant impact on the burden of this disease. Also the adolescent female population has been left out of both national data collection efforts and interventions. Adolescence is an ideal time for detection and correction of anemia prior to pregnancy. In many states in India the average age at marriage for girls is 15 years old, and by 19 years of age, 36% of women have begun childbearing, making the adolescent years an essential time for intervention. Accurate measurement of anemia is essential to providing adequate care and treatment.   Clinical examination and current measures employed are inaccurate and require a pinprick, which may cause pain, discomfort and increased risk of infection for the participants. There is a critical need for accurate and acceptable hemoglobin monitoring tools for resource-limited settings, accurate prevalence data in adolescent females and an understanding of the factors contributing to poor compliance of iron folic acid interventions.  The Pronto-7 device (Masimo) is a FDA approved pulse oximeter that provides accurate hemoglobin estimation. 

The objectives of the study are the following:

  • Determine the prevalence of anemia amongst adolescent girls and pregnant women, using the FDA approved Pronto-7 device,
  • Elucidate factors contributing to the high burden of anemia, as well as reasons that current interventions are failing to achieve a significant impact.

The results of the study will help us lay the foundation for a culturally acceptable educational or incentive based program aimed toward eradication of anemia in rural female population in India.  Eliminating iron-deficiency anemia in this population will help reduce maternal and child mortality.  

Education Opportunities

Pediatric “Longitudinal Elective in Global Health” (LEiGH)

The Division has established a rigorous pediatric global health curriculum that provides residents an essential understanding of how to deliver effective clinical care in resource-poor settings and unique clinical needs of immigrant families for whom residents provide care in their continuity outpatient clinics. Energetic faculty members collaborate to provide expert resident training in global health through engaging presentations interspersed in the resident longitudinal curriculum and mentoring residents in global health clinical elective experiences. Topics include global burden of disease, child nutrition, newborn and maternal-child health, and infectious diseases, global health professionalism, and practical skills that you “must know before you go” on an international elective.

Residents have the opportunity to work globally during Global Health Clinical Electives in safe, mentored, and educational environments. Our residents have worked at well-developed sites in Botswana, Uganda and Mexico. Some residents have opted to coordinate their own elective sites, with vetting and approval from the Division of Pediatric Global Health. These have included Tanzania, Guatemala, Haiti and Geneva. Our 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.

“Clinical Topics in Global Health,” a Global Health and Tropical Medicine Course at Harvard Medical School

This global health course, co-directed by Brett D. Nelson, MD, MPH, DTM&H, and Peter Moschovis, MD, is a novel clinical skills-based curriculum established for Harvard medical students and residents with the primary objective of providing participants with essential clinical knowledge and skills to work effectively in resource-limited settings. The course consists of 10 evening sessions taught by a multidisciplinary faculty, with curriculum focused on the practical management of the leading causes of mortality and morbidity in low- and middle-income countries.

Currently there are three overseas sites where MassGeneral Hospital for Children residents can participate in mentored clinical electives.

Botswana

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 west. The population is slightly greater than 2 million people. Formerly a British Protectorate, in 1966 Botswana gained its independence 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. The 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. PEPFAR funding continues to support activities to control Botswana’s HIV epidemic. In late 1990s, Professor Max Essex of the Harvard T.H. Chan 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, public health policy, 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 substantial 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.

Chiapas, Mexico

Please contact Kate Powis with questions regarding this site.

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. With a population of 37 million, Uganda is one of Africa's largest and fastest-growing countries. Despite rapid economic growth realized in the past decade, many Ugandans still live in poverty and confront several social and economic inequities: 65 percent of its population lives on less than US$2 per day. Training and retention of professional health staff is a serious problem, and Uganda is no exception. Under the auspices of the Mass General Center for Global Health, Mass General 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 Mass General departments of Pediatrics, Medicine, Surgery, OB-GYN, Anesthesia, and others regularly visit MUST to collaborate on research and education. Additionally, the Bugoye Health Center is a primary training site for residents in the Mass General Global Primary Care Program.

Faculty in the Department of Pediatrics at MRRH, in the Mass General Center for Global Health, and in the Division of Pediatric Global Health at MassGeneral Hospital for Children are engaged in a diverse focus of research, including malaria, TB, pneumonia, HIV, and neonatal resuscitation. A collaborative initiative is presently underway to develop a regional oncology center at MRRH, with support from the Mass General Cancer Center and the Uganda National Cancer Institute.

At the Mbarara Regional Referral Hospital (MRRH), Mass General 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 resource-constrained setting. Mass General pediatric faculty are currently active in research projects and medical education at MUST, and provide close mentorship and support for pediatric resident who chose to train at this site. The contact person for this site is Dr. Kate Powis.

Contact

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Division of Global Health

8th floor125 Nashua Street Boston, MA 02114

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