Sharing lessons from an “age of belief and incredulity” and “an epoch of wisdom and foolishness,” researchers and physicians from Harvard Medical School, the Harvard School of Public Health and Brigham and Women’s Hospital met at a symposium on Nov. 25 to discuss the challenges and accomplishments occurring in what researchers at the event called the often-Dickensian world of global health.
The summit, which convened what HMS Dean Jeffrey Flier called a “dream team” of global health innovators, was conceived by Betsy Nabel, president of Brigham and Women’s.
Flier, Nabel and HSPH Dean Julio Frenk welcomed visitors to a series of panels featuring informal presentations and candid conversations about working in the global health field.
The afternoon’s keynote panel featured Paul Farmer, the Kolokotrones University Professor at Harvard and head of the HMS Department of Global Health and the Brigham and Women’s Division of Global Health Equity; Atul Gawande, director of Ariadne Labs: A Joint Center for Health Systems Innovation at Brigham and Women's Hospital and Harvard School of Public Health; and Nawal Nour, director of global obstetrics and gynecologic health in the Department of Obstetrics and Gynecology at Brigham and Women’s.
Panelists shared their personal inspirations along with lessons learned in researching and implementing high-impact, creative solutions to the challenges of delivering high-quality, affordable care to all who need it in places as diverse as Boston and rural Rwanda.
In the afternoon’s first panel, which looked at “The Global Health Experience: What We Can Learn,” Andy Ellner, co-director of the HMS Center for Primary Care and associate physician in the Division of Global Health Equity at Brigham and Women's, began his talk with a reference to the incredulity, wisdom and foolishness mentioned in the opening lines of Dickens’s “Tale of Two Cities.” Ellner compared the inspiring power of medical technology available in Boston with the daunting challenges of dealing with complex cultural, social and economic determinants of health in the constraints of the current primary care settings.
Ashish Jha, professor of health policy at HSPH and associate physician at Brigham and Women’s, discussed the challenges of applying innovative, affordable solutions that have been deployed in other countries to the needs of the U.S. health care system, and Michael VanRooyen, director of the Harvard Humanitarian Initiative outlined the need for specialized training, new systems of coordination and careful analysis of shared data to implement evidence-based practices in humanitarian medical relief, which he called the “ER of global health.”
Another panel, led by Frenk and faculty from HMS, Brigham and Women’s and HSPH, were joined by partners from foundations and nongovernmental organizations to discuss the challenges of “Mobilizing for Global Health.”
The keynote panel, moderated by NPR journalist Robin Young, was titled, “To Alleviate Human Suffering: Our Work to Strengthen Global Health Care.”
Foolishness and wisdom
“There’s no mistake that’s too dumb for us to make,” said keynote panelist Gawande, a professor at HMS and HSPH.
Gawande said he has made a career out of studying and writing about the simple errors that can cause so much harm in complex systems that provide health care. He said he also works to develop simple methods—such as creating checklists—to overcome those barriers.
Throughout the event, panelists highlighted the need to build systems, negotiate cultural change (within many populations, including physicians and patients) and work collaboratively.
Several presenters stressed the important role of academic medical centers in collecting and analyzing data that can be used to disseminate best practices and policies based on measurable outcomes.
Many also noted that not every challenge in global health needs a doctor to solve it, citing the importance of basic biomedical research, engineering, architecture, economic development, construction, business, law, nursing and logistics, to name a few.
Another common theme was the importance of building relationships between global health workers and the patients and populations they serve. Ellner noted that while almost every aspect of our contemporary health system could stand to be improved, the one thing that will not change in a successful new health delivery system is the importance of human contact between caregiver and patient.
These relationships are equally important for global health workers in the roles of researcher and policy advocate, noted Nour, also director of the African Women’s Health Practice, Brigham and Women’s Hospital, and HMS associate professor of obstetrics, gynecology and reproductive medicine.
“I’m not somebody who’s big on labels, so take the labels away,” Nour said. “You’re not just a researcher, you’re a person talking to another person.”
Incredulity and belief
For Christopher Flowers, financier and founder of several anti-malaria initiatives, the funeral of a child who died from malaria helped crystalize the importance of preventing the transmission of the deadly disease even in remote communities “at the end of the road.”
So many children died from the illness in the community Flowers visited that the all-too-common loss of a young life was not seen as shocking or surprising by the local community. Flowers said he decided to dedicate his work to making sure the death of a child from preventable and treatable diseases would no longer be seen as normal.
Many panelists shared this sense of disbelief that it can be considered normal for the poor to lose their lives and their health. They also shared a sense of optimism in the ability of global health workers to help prevent diseases of poverty as they build platforms to treat noncommunicable and surgical diseases in resource-challenged settings.
What gives them this sense of hope?
“We’re all convinced that these are problems that can be fixed,” said Farmer, who is also a founding director of Partners in Health.
In the last two decades, Rwanda has doubled the lifespan of its people, making huge advances in its struggle with malnutrition, infant and maternal mortality and HIV/AIDS. Using a strategic approach and systemic thinking, Farmer said, and with the help of outstanding leaders such as Rwandan Minister of Health Agnes Binagwaho, astonishing progress is possible.
“In Rwanda, we’ve seen the steepest declines in human mortality ever documented anywhere—what’s not uplifting about that?” Farmer asked.