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



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


“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.


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.

CUGH, GHEC Awards Ceremony- Winners

November 15, 2011

CUGH Early Career Award:

Dr. Nancy Glass, Johns Hopkins University Global Health Center

Anvar and Pari Velji Award for Global Health Excellence:

GHEC Emerging Leaders in Global Health- Emma Lawrence, Univ of Michigan
Global Health Project of the Year-  Univ of Washington Team- Drs Kim, Harrington, Chung
Faculty Award for Teaching Excellence- Sten Vermund, Vanderbilt

Student Poster Abstract Awards:

Ashley Elsensohn, Univ of Utah
Mariam Fofana, John Hopkins School of Medicine
Lawrence Mumm, Mount Sinai School of Medicine
Melissa Reimer, Univ of South Alabama College of Medicine
Keila Veiga, Univ of Connecticut
Claudi Vela, Hopital Masonneuve-Rosemount
Yae Yoshino, Kitasato Univerity

Session 33: GHEC/CUGH Educational Priorities: Seeking Your Input

November 15, 2011

By Lisa Croucher, Duke Global Health Institute

Representatives from the GHEC-CUGH Education Transition Committee hosted this session to report on progress toward defining the education mission of the GHEC-CUGH partnership and to solicit input from participants on education priorities. The committee was formed to prepare recommendations on the goals and scope of education activities, core competencies (specifically in the areas of undergraduate education, law, environmental science and business), activities that would link education to service and research, integration and continued development of existing GHEC materials, and the scope of the student advisory council.

After distributing a document highlighting the accomplishments and products of GHEC, the presenters shared the charge of the transition committee and its recommendations, which will be available on the GHEC web site. During the discussion period, participants addressed both the regional and topical scope of “global health education” and debated to what extent global health education should include non-medical, non-clinical, and “non-health” fields. Some participants felt that global health education should take a more inclusive and comprehensive approach, involving business, law, anthropology, economics, etc.; others discussed global health education more in terms of medicine, public health, veterinary sciences, dentistry, nursing, etc. One of the panelists noted that the CUGH and GHEC are comprised overwhelmingly of individuals and institutions associated with medicine and that disciplinary diversification should be a priority.

(Note: the CUGH recently added three new members to its board, from the disciplines of law, engineering, and veterinary medicine.) The Education Transition Committee continues to solicit input on the educational priorities of GHEC-CUGH.

Plenary: Cancer and other chronic diseases

November 15, 2011

By: Lauren Beaudry, Duke Global Health Institute

Eighty-eight percent of the women who die from cervical cancer and sixty-three percent of the women who die from breast cancer live in low or middle-income countries. These are the staggering statistics presented today by Dr. Felicia Knaul, associate professor at Harvard Medical School. Dr. Knaul, a breast cancer survivor herself, is working to bridge the divide in cancer care between developed and developing nations. While cancer knows no economic boundary, people living in poor areas are disproportionately suffering from treatable and preventable cancers. 

In addition to disparities in treatment and prevention, Dr. Knaul also addressed the fact that pain control or palliative care is almost nonexistence in many LMICs. In her work to expand access to cancer care in developing countries, Dr. Knaul proposes a “Diagonal” approach to setting priorities and addressing gaps in the health system. 

Dr. Knaul also states that not only is expanding cancer care in developing countries necessary and appropriate, it is also predicted to be cost-effective. Broad estimates suggest that increases in cancer care could lead to 130-850 billion dollars worldwide. At the end of her engaging and thought provoking presentation, Dr.

Knaul reminded us all that cancer care is not about the disease, but it is about people and that this is what we need to remember when moving forward with global cancer care and research.

Session 26: Ethics and Global Health Research

November 15, 2011

By: Jennifer Kitts, Consultant

Several speakers participated in the session “Ethics and Global Health Research” on Monday afternoon. The session was moderated by Ibrahim Daibes, of the Global Health Research Initiative. The speakers highlighted that ethics in global health research goes far beyond what many traditionally think of as “research ethics” – such as getting approval from a research ethics board, getting informed consent statements, and so on. The issue is much more wide-ranging.

“There are various ’ethical stops’ in the knowledge-to-action cycle of global health research where one can pause and reflect,” said Kristiann Allen, of the Canadian Institute for Health Research (CIHR).

The speakers discussed various ethical questions that can be explored during the research process, including:

–          To what extent does your discipline or theoretical perspective influence the research agenda?

–          Are you conducting research because you are “following the money” (the priorities of funders)? Is it the most relevant research?

–          How do you choose collaborators?

–          How do you ensure that there is an ethical partnership in the case of collaboration between researchers from the North and the South? What are the power dynamics?

–          In the process of knowledge translation, what information is ‘privileged’?

–          What are the ethics of sustainability? What will happen once the project finishes?

–          What is the best way to handle ethical issues related to knowledge ownership? “What if a government official want to have his name appear on the study, but he did nothing?” asked Martin Forde.

Erica Di Ruggiero of CIHR raised some important questions concerning the role of funders in determining the research agenda and the extent to which various forces influence the priorities of funders. “Why do funders allocate resources to some issues and not to others?” she asked. She added that, “funders have to look at the ethical implications of their decisions and where they put their dollars – ultimately it’s a resource allocation issue.”

Susan Tilley ofBrockUniversity encouraged researchers to explore the extent to which the “sociocultural identities that we carry influence the research process.” She asked, “what preparation is necessary to ensure that we conduct respectful research?”

Karin Morrison said that there are, “a complex network of moral relationships that change over time as we pass through the research process.” She emphasized that, “there are techniques and tools that can be applied to navigate challenges and come to a resolution.”

The session was very positively received, and generated a number of questions and comments, as well as the sharing of personal experiences and challenges, from audience members.

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.

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