Empathetic Innovations in Healthcare: The patient experience project: Session at 2012 NCIIA Conference

March 26, 2012

Jim Agutter at the University of Utah is looking at the healthcare system in a new way. When one goes into a hospital they enter a world full of confusion. Doctors and nurses seems to be speaking another language, you take off your clothes to put on scratchy new ones to then laid on a table where you feel more like a car in the shop instead of a human. Because of all the unfamiliarity, patients commonly are anxious and scared, which ultimately affects their recovery. Agutter described how the human element has been taken out of the healthcare system and patients’ anxiety is not taken into account.

In order to put the human element back into the healthcare system, Agutter has developed a program of a small group of students that are focused on designing innovations for the current health care system. These students work closely throughout the semester, following doctors, nurses, patients, administrators and family members through the process of healthcare to get a holistic picture of the challenges with the current system.

One project addressed the simple lack of information about the healthcare process by creating a map with information of what to expect in the hospital each step of the way. This map contains information in a clear readable way for all education levels with the ultimate goal of easing patients’ anxiety. From development in Agutter’s class, this map has gone to market and currently in the process of being developed for a local hospital. Taking the patients’ concerns and needs in to account in a hospital seems like it should be the norm, however this is an innovative program because it take nothing for granite. This program reevaluated the healthcare system thoroughly and finds ways to address the needs of the patients.


Brillance- Design Revolution

March 26, 2012
Brillance D- Rev

Picture from NCIIA OpenMinds Event

Newborn jaundice is a very common condition that affects 50-60% of all babies born. However, if left untreated, it can lead to very serious problems such as brain damage or death. Phototherapy treatment has been the standard form of treatment and in the United States, the associated costs have dramatically decreased in recent years, leading to a decrease in infant mortality. In many developing countries however, only a small segment of the population has access to treatment services. In Africa, there is an estimated unmet need of 3.8 million and another 2.8 million in Asia.
With these numbers in mind, a student from Stanford University named Ben Cline set out to create an affordable and efficient LED-based phototherapy device, which has developed into the Brillance project. Brillance is noteworthy and innovative because it can effectively treat 413 babies before the bulb needs replacing as compared to 83 babies on an older, fluorescent-based phototherapy device. The costs associated with maintaining Brillance are much more reasonable as well; both the light bulbs and the machine itself, cost a fraction of what fluorescent devices do.
Brillance has partnered with a technology non-profit called Design Revolution to develop the device and it is being introduced later this year at health clinics in the rural districts of Tamil Andu, India. With all the hype that has been generated about their product, they have started to take pre-orders from doctors and clinics in Liberia, Pakistan, Nigeria and Egypt. The eventual goal is to make the device available to everyone who needs it, especially those in Sub-Saharan Africa. Another amazing idea that is saving lives and changing the world, that’s the power of Open Minds!

-Katia Chikasuye, focus in environmental studies and global health

http://www.d-rev.org/projects/brilliance.html

http://nciia.org/openminds/2012/brilliance


Strong Arm and IdeaLab

March 26, 2012

Strong Arm and IdeaLab

(left to right):
RIT’s IdeaLab professors: John Schull, Carl Lundgren; Strong Arm Team Justin Hillery (wearing product and holding their Winning Pitch certificate), Sean Pettersen

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“Lifting injuries cost [U.S.] industries $50 billion each year,” say weight-lifting enthusiasts Justin Hillery and Sean Petterson of Rochester Institute of Technology. That’s a lot of back ache.

However, if graduating seniors Hillery and Petterson secure the $50,000 they need for the next testing phase of their “Strong Arm” back brace and vest, the world may see some relief very soon. Over the last 1.5 years, the two designed and tested a vest that helps to direct the weight of heavy loads to strategic points of the back and torso where we’re strongest. This, they say, will go far in helping lifters to minimize and/or avoid injury. Their priority markets in the short-term are the materials handling market (think “construction” for example) and healthcare where workers are often called upon to lift patients from wheelchair to bed and so on.

Through a cord crisscrossing the back of the vest that connects to attached gloves in the front, the lightweight apparatus maneuvers the body to assume the proper posture for lifting when a lifting force occurs. When not lifting, the vest simply relaxes.

The prototype was presented Thursday at the National Collegiate Inventors and Innovators Alliance (NCIIA) conference in San Francisco, where Hillery and Petterson were one of 14 student teams presenting their inventions to the general public. There, selected teams also presented 3-minute video clips where they “pitched” their inventions. The RIT duo won $1,000 for the “Best Video Pitch”.

They were elated, but not too surprised. Product market-readiness aside, they have also been working very hard on their pitch. In January 2012, the two gym enthusiasts participated in a NCIIA IdeaLab 4-day boot camp where about 30 entrepreneurial students from multiple schools came together to learn and practice the necessary steps to successfully take a product from concept to market. Petterson and Hillery’s Strong Arm was not born by the crash course, but their winning pitch was. With the importance of the pitch drilled into them. They reworked theirs, won the NCIIA competition in the category on Thursday, and earlier the same day, Strong Arm Technologies Inc. was the only student-owned company chosen to pitch to investment group Hi-Tech Rochester. “We’re proud daddies,” beamed RIT professors Jon Schull and Carl Lundgren, who lead the IdeaLab January. They should be. The Strong Arm team is competing with far more experienced businessmen for Hi-Tech Rochester’s funds. While final decisions have not yet been made, the young entrepreneurs remain strong in the running.

http://industrialdesign.cias.rit.edu/2012/03/24/nciia-best-cutting-edge-innovation-strong-arm/


New course addresses ethical challenges in global health training

November 28, 2011

The Center for Innovation in Global Health with the Johns Hopkins Berman Institute of Bioethics has just launched a new interactive, web-based course on ethical challenges faced by trainees during short-term global health rotations. The curriculum and course includes 10 cases, each with three interactive vignettes, that address important ethical challenges targeted towards individuals from diverse disciplines with little or no prior experience in global health. Each case requires less than 10 minutes to complete and allows users to print a certificate of completion.


Session 25: Government-University Partnerships for Global Health

November 14, 2011

By: Lisa Croucher, Duke Global Health Institute

Roger Glass

Dr. Roger Glass, Director of the Fogarty International Center (FIC) at the US National Institutes of Health (NIH), outlined opportunities for training and research in global health as envisioned by NIH and by FIC and its international collaborators. Glass highlighted sample FIC programs and partnerships, including those with universities, with other NIH centers and institutes, with the private sector, and with the governments of other countries.

Glass stressed the importance of providing young scientists with substantive, innovative and well-mentored research opportunities early in their career, comparing those experiences to “early childhood education.” To reinforce his point, Glass presented a slide showing the career trajectories of early participants in the AIDS International Training and Research Program (AITRP) that was established by FIC in 1988 to train scientists in developing countries to address the AIDS epidemic. He noted that each of the trainees had gone on to successful and impactful careers in HIV/AIDS research and policy and, notably, they all had returned to work from within their country of origin. “These people represent sustainable research in the developing world,” Glass said. Dr. David Serwadda, Professor of Public Health at Makerere University in Uganda, who is in attendance at the Montreal conference was one of the early AITRP trainees featured on the slide. Glass underscored the importance of these sustained relationships with and between researchers all over the world noting that those relationships “build the bridges between those with eyes in the sky and those with their feet on the ground.”

In keeping with his early childhood education and “lifespan” theme, Glass noted that most of the US-based leaders in global health were early beneficiaries of FIC programs. He also noted that they all are “old white men” who were trained as infectious disease physicians. He then projected a slide showing “Tomorrow’s Leaders in Global Health,” a smiling group of young FIC-supported men and women from all over the world addressing global health challenges from multiple cultural and disciplinary perspectives.

Glass described NIH’s burgeoning partnerships with the BRIC (Brazil, Russia, India, and China) countries and presented specific funding programs that were jointly developed by NIH with the Indian and Chinese governments, both of which have been increasing investments in health research. Glass described these collaborative programs as a “way to get twice the results with half the cost and at a quicker speed.”

In addition to promoting and supporting global partnerships, FIC is promoting the exploration of emerging technology to support current and future global health research. Glass noted that cellphones can now be used to access Medline, to examine cells with a lens-free microscope attachment, measure activity and diet, and monitor adherence to anti-retroviral treatment. “New technology is game changing” in health research, Glass said.

Fogarty has recently partnered with the Fulbright program to establish a Fogarty-Fulbright Fellowship in Public Health to promote the expansion of research in public health and clinical research in resource-limited settings. The first four fellows were selected in July 2011 to work in three countries, and FIC hopes to extend to 16 countries in the coming year.

Glass noted that an increasing number of NIH institutes and centers are supporting global health programs and activities. Global health is no longer contained within NIAID, NCI, and the Office of AIDS Research. Similarly, FIC is supporting not only projects that are based in traditional health areas, but also innovative programs that involve law, ethics, economics, engineering, decision making, anthropology, and a range of social sciences. He pointed to the FIC Framework Programs for Global Health Innovation as an example (http://www.fic.nih.gov/programs/pages/framework-innovations.aspx).

 The FIC strategy will continue to focus on non-communicable diseases, implementation science, building and supporting new partnerships, maintaining core emphasis on training for research, and supporting the efforts of NIH in global health. Glass also appended global mental health to the list of strategic directions. He called on universities to encourage electives and rotations in developing countries for students and residents, build partnerships and twinning relationships, and address health disparities at home and abroad (engaging what he called the “glocal” community).

Glass concluded his talk by stressing that supporting global health efforts is good for science, diplomacy, humanity, business and competition, good for the war on terrorism, and good for our own future. In short, he said, it’s the right thing to do. “These are wonderful times,” he said, “and we have to take advantage of it while we have it.”


Session 21: Lancet Commission Report on the Education of Health Professionals for the 21st Century: from Concept to Implementation

November 14, 2011

By: Lisa Croucher, Duke Global Health Institute

Three renowned international leaders in medical education offered perspectives on the implementation of the 2010 Lancet Commission Report, Health professionals for a new century: transforming education to strengthen health systems in an interdependent world (http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2810%2961854-5/fulltext).

Julio Frenk

Dr. Julio Frenk, Dean of the Harvard School of Public Health and co-chair of the initiative that produced the report, introduced the Commission’s work and positioned the resultant report in the context of historical trends in both instructional and institutional development over the past 100 years. With the publication of the landmark Flexner Report in 1910, the instructional focus of medical education shifted to basic and clinical sciences, and the university became the institutional home for medical education. Beginning in the 1970s, the instructional focus shifted to a problem-based curriculum, as academic medical centers were established to provide the institutional foundation for problem-based medical education and research.

The Lancet Commission report espouses the importance of a competency based curriculum that integrates education systems with health systems, on a local, national, regional and global level. Frenk explained that in the new model, “populations,” who previously may have been viewed as clients or consumers of a health system, are now seen as fundamental stakeholders and contributors to the design of an integrated education and health system that addresses real needs in the workforce. To date, systemic failures in the education of health professions have produced a “fundamental mismatch of competencies to needs” leading to an excess of “doctors without jobs and jobs without doctors.”

The Commission report, which has been formally launched in 20 locations worldwide and has been translated into 6 languages, articulates 10 specific recommendations for instructional and institutional reform that links education and health systems. The desired result is an integrated system that produces change agents trained to address real local and global health needs.

David Serwadda

Dr. David Serwadda, Professor of Public Health at Makerere University, presented on the distribution and reception of the Commission report in Uganda and its relevance to the Sub-Saharan Africa context. Serwadda predicted that by 2050, 1/5 of the global population will live in Africa, noting that Africa will see “a refugee situation in slow motion” as huge portions of the population migrate from rural to urban areas, resulting in 60% of Africa predicted to be urbanized by 2050. Serwadda observed that, meanwhile, there is a “huge hemorrhage of physicians from Sub-Saharan Africa” to higher-income regions of the world (regions that Dr. Frenk cleverly referred to as the “undeveloping world”).

“Many of the recommendations in this report have been going on at Makerere for many years,” Serwadda said. “The report resonates with what some of these institutions have already been doing and it reinforces that this is something right for us to move forward.”

Zulfiqar A. Bhutta

Dr Zulfiqar A. Bhutta, Chair of Division of Women and Child Health at Aga Khan University, presented the state of health education in Pakistan and summarized the activities related to the Lancet report. Challenges to the training and maintenance of a health workforce in Pakistan include the fact that most medical colleges are in urban centers and that of approximately 6200 physicians trained each year, about 1700 are “lost” due to emigration or decisions not to enter the workforce, namely that many of the female graduates go on to raise families instead of practice medicine.

In the late 2000s, Prime Minister Benazir Bhutto implemented the largest community health worker program in the region which positioned lady health workers as the backbone of community health services. Pakistan now has a health system that bulges with physicians, albeit poorly distributed, and with well-trained lady health workers but with few other intermediary cadres of health workers. The government is focusing its attention on task shifting and on care in rural areas.

The Lancet report has been distributed and discussed widely in Pakistan, in both formal and informal settings, by the leaders of 26 medical schools, universities and postgraduate colleges, with many having discovered and read the report on their own prior to having been invited to discuss it at a national level.

 The leaders expressed “intense interest and broad agreement with the report” and identified primary challenges to its successful implementation – lack of resources (faculty, financial, transportation), a “dysfunctional health system,” and clarity and relevance of the competency requirements which address local and global or regional needs. They developed specific action points to address each of the identified challenges.

And then, in June 2010, the Pakistan Ministry of Health was abolished, as curtly noted here: http://www.health.gov.pk/. As a result, all health planning was shifted to the district and provincial levels, which are now embarking on the same planning and analysis that was already conducted at the national level.

Uganda and Pakistan provide enlightening case studies of the potential impact of the Lancet Commission report, as well as acute examples of the challenges involved in implementing its recommendations.


Lunch Topic Table: Sex and Gender

November 14, 2011

By: Laura Pascoe, GHEC Student Advisory Committee

During the lunch hour on Sunday, students, faculty, and other conference participants had the opportunity to discuss a topic that is fundamental to global health work and research, but often not discussed: Sex and Gender.

We broke up across four tables and three themes to discuss how to think about theoretical approaches to sex and gender; empirical methods for researching them; and how to get the word out about the importance of understanding the impacts and implications of sex and gender (knowledge transfer).  One of the important questions that came up in the in terms of theoretical approach was whether we need to study gender in global health, or if we need to mainstream gender (and understand the implications) in global health. The answer, which received wide agreement, was that we need both.

There was also a valuable discussion about the critical nature of understanding a local context before making assumptions about how gender and sex influence life in that environment, and the need for local conceptualisations of gender and feminism to inform our work. It is imperative that we incorporate sex and gender in our work, many agreed, but we must be careful not to perpetuate imperial assumptions of what is ‘best’ for men and women.  

The importance of engaging men and understanding masculinity in our pursuit of promoting gender equality was raised in a few groups. Discussions around empirical methods brought up the challenges of asking people to tick potentially overly simplistic male/female boxes in our data gathering, as well as the importance of doing both quantitative and qualitative research in order to truly understand the complex dynamics of sex and gender that impact daily life in all parts of the world. 

We then finished up with a discussion of knowledge transfer, which raised some great points about how gender is not traditionally given its due place in global health and medical curricula. We need to advocate for greater incorporation of sex and gender on our various campuses and highlight its value in global, public health and medicine, not just because many people are interested in it, but because the impact and implications of sex and gender are integral to improving the health and well being of men, women, and children.


Debas, Deckelbaum, Wotton Receive Lifetime Achievement Awards

November 14, 2011

Lifetime Achievement Awards were given to three very deserving global health leaders Sunday night. 

Consortium of Universities for Global Health Lifetime Achievement Award: Haile Debas

Haile Debas

Haile Debas of Univ of California-San Francisco.  A native of Eritrea, Debas is recognized internationally for his contributions to academic medicine and is widely consulted on global health issues. Through his leadership and vision, Debas has driven the conceptualization and creationof UCSF Global Health Sciences, the Univ of California Global Health Institute and the CUGH.

He has held numerous leadership positions throughout his distinguished academic career, including Chancellor and Dean of the Univ of California, San Francisco School of Medicine, and chair of the Dept of Surgery.

GHEC Lifetime Achievement Award: Richard Deckelbaum

Richard Deckelbaum

Richard Deckelbaum is President of the Global Health Education Consortium and Director of the Institute of Human Nutrition at Columbia University. Early in his career he was a physician in Zambia, and helped establish the first children’s hospital in the West Bank of Jordan. He now directs the Columbia side of the Medical School for International Health.

CSIH Lifetime Achievement Award:  Kay Wotton

Kay Wotton is community health specialist with the University of British Columbia and community health educator with Frontier Health Care in NWFP Pakistan and Healthy Child Uganda.  Wotton was not in attendance Sunday evening because she is on assignment in Uganda.


Session 15: Global Health and the Media

November 14, 2011

Dan Green

By: Mathura Thevarajah

Media Panel

The sobering perspectives of the speakers in this session regarding global health and media aroused an artillery of questions at the end, all the while keeping the audience engaged, humoured, and informed. 

Dan Green from the Gates Foundation began his talk by comparing global health coverage to the broccoli of news. The media landscape is changing with a greater number of voices constituting more opinions and less facts, he explained. In essence, reporting is expensive, talk is cheap.

“Accountability in journalism is in serious jeopardy and the solution is that philanthropists and experts have to step up to the plate.”  One example he gave was how The Guardian puts out a newslist of potential topics for the day on their website and asks for experts in the field to send input for the pending paper. We have to make sure that “informed and engaged citizen who are doing really great work are getting their voices elevated within the media framework,” he said.

Donald J. McNeil of the New York Times began his talk with endearing self-deprecating humour that quickly turned searingly honest. Usually inundated with global health stories that just don`t have a chance of being published, he cried out for an angle, “something I don`t already know”. He clarifies, though, that he`s not that cold, otherwise he wouldn`t stick to it. 

Next, Andre Picard of the Globe and Mail illuminated the idea that even though the Globe and Mail is one of the 10 biggest newspapers in North America, with a foreign bureau that is continuously increasing, and a largely multicultural audience, global health is often just an afterthought. Global health coverage is reactive and responds to crisis where writers are dispatched on-demand. Part of the problem is that most reporters don`t have a health or medical background and comprise of a younger technology -savvy, albeit “green behind the ears” generation of journalists. Another problem is bridging the gap between health care professionals and journalists. Health care workers see reporters as “ill-informed and intrusive” and reporters see health care workers as “obstructive, prickly and unhelpful”.  There needs to be open dialogue and more understanding between the two groups in order to foster a healthy symbiotic relationship.

According to Green, global health coverage in the media is like symphonies in small towns; someone has to pay for it out of pocket because ticket sales just won`t cut it. Despite the lack of coverage for the vast array of important global health topics,  the take home point of the panel was that health care workers should never lose their passion and drive for their work. Afterall, as Picard jokes, “it may be broccoli but you can always put a lot of cheese sauce on it.”


Session 2: Infant Mortality and Micronutrition

November 14, 2011

By: Lindsey Lenters, RD, University of Toronto

As a Dietitian and Masters of Public Health student, the session on infant mortality and micronutrition was on the top of my list of break-out sessions! Much of the discussion centered on the treatment of childhood diarrheal disease using zinc supplementation and oral rehydration. Zinc was recognized as an essential nutrient many decades ago. Yet it’s only in recent years, through the work of the panelists and other researchers that we have begun to understand the impact of zinc on child development and diarrheal disease.

Perhaps the most captivating aspect of this session lay in the discussions that stemmed beyond zinc, to look at the challenges faced in scaling-up and sustaining nutrition initiatives. Sue Horton pointed out that nutrition interventions have not benefitted from increased funding for global health initiatives to the same extent as issues such as HIV/AIDS and TB, despite an established evidence-base of effective nutrition interventions, as well as compelling cost-benefit arguments. Charles Larson touched on the need to better understand decision-making processes at the household level in order to see the uptake of micronutrient interventions. Mark Fryars spoke to the need to apply an equity lens to scale-up efforts, in order to ensure that interventions cover those in need, not just those in reach.

The issues surrounding malnutrition are complex and will require long-term, sustained attention from the public and private sectors.  There is a long road ahead, yet this session beautifully captured the growing momentum and energy around nutrition in global health.

The lingering thoughts in my mind revolve around the issue of the “medicalization” of nutrition, and what might be lost if we do not seek to understand the daily contexts and personal meanings of food and nutrition.


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