HMS/HSDM Class Day
• Martin Offers Grads Guides for Listening
and Leading
• Grads Take a Look at the Bigger Picture
HSPH Class Day
Health Care Is a Right, Asserts Former Mexico Health Minister
Class Day Photo Gallery
Congratulations in Order
Faculty Symposium
Getting to the Molecular Heart of Heart Disease
Class Symposium
• Class of ’82 Recounts Paradigms
Passed
• Alums Share 25 Years of Adventure, Inspiration
Alumni Symposium
HMS Initiative Urged to Break Implementation Bottleneck
Brain Size and Signal Decline with Advance of Schizophrenia
Tail Injection Cures Brain Inflammation in Mice
Regulatory T Cells May Lull Immune Activators to Sleep
McNeil to Serve as Acting Medical Dean
Sports Medicine Makes Gain with Thorndike Chair
ALUMNI SYMPOSIUM
HMS Initiative Urged to Break Implementation Bottleneck
Jeff Thiebauth
During Alumni Day on the Quad, Sonya Shin, ’98, told the intertwined stories of a small organization (Partners In Health) that took on a big disease (multidrug resistant tuberculosis) and her experience as a medical student working with PIH in its first year in Peru. Now an infectious disease specialist at Brigham and Women’s, Shin consults and conducts research for PIH in HIV and TB. |
Ten million people around the world die needlessly every year because proven remedies are not reaching them, said Jim Kim, head of the Social Medicine Department at HMS, during the Alumni Day Symposium on the Quad.
The bottleneck may be most extreme for poor people or those in developing countries, but it can affect people’s health everywhere, Kim said. A mere 3 percent of African children have access to the pesticide-impregnated bed nets that protect them against deadly malaria-spreading mosquitoes, for example. On the other end of the spectrum, only about two thirds of U.S. patients receive beta blockers within 24 hours of admission to a hospital with chest pain.
“We are in the midst of an implementation bottleneck,” said Kim, who proposes that Harvard launch a new field of health care delivery science. “Many people are working on new tools, which is terribly, terribly important,” he said, “but what about getting the things we already have out to the people who need them?”
A common thread in the long list of bottlenecks is complexity, said Kim. Many people make the mistake of fixating on one aspect of multidimensional problems whose solutions require many different approaches, none of which is sufficient by itself. For example, the billions of dollars from the Bill & Melinda Gates Foundation for discovering and developing new drugs and vaccines to combat diseases in poor countries is vitally important, he said, but an implementation bottleneck remains a huge barrier to delivering the improved health care to the people who need it.
“There has to be a way to capture the complexity, learn the important lessons, and then train leaders in global health delivery,” he said. “I fear that it’s not going to happen unless Harvard Medical School takes a leading role in doing it.” Kim, a co-founder of Partners In Health (PIH), envisions a cadre of people with the skills of two other symposium speakers who trained on PIH projects in Haiti, Peru, and Russia.
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“There has to be a way to capture the complexity, learn the important lessons, and then train leaders in global health delivery. I fear that it’s not going to happen unless Harvard Medical School takes a leading role in doing it.” |
Sonya Shin, now an HMS assistant professor of medicine at Brigham and Women’s Hospital, joined PIH at its new outpost in northern Lima, Peru, during her third year at HMS 11 years ago. An initial door-to-door survey of health issues, combined with the death of a relief worker colleague from multidrug resistant tuberculosis upon his return to Boston, quickly focused their efforts on the growing number of TB cases resistant to all first-line therapies.
First the organization had to overcome the prevailing dogma of the World Health Organization, which considered Peru a model country for TB treatment and balked at programs to treat resistant cases. Then, Shin faced the same problem on a smaller scale, a patient whom the local hospital wanted to declare ineligible for treatment because of her history of no-shows. The patient, Paulina, was so sick she could not walk to the hospital to complete the procedures necessary for treatment.
“Patients were dying of the policy, not the disease per se,” said Shin, who de-cided to treat Paulina while the admin- istrative delays were being overcome.
Another PIH colleague, David Walton, described his efforts in expanding HIV and TB treatment in Haiti from the central hospital to Lascahobas, an inland town of 55,000. “The secret was to raise the level of primary care and integrate [treatment] into the larger paradigm of creating access to care for those who didn’t have anything,” said Walton, who just graduated from the Howard Hiatt Residency in Global Health Equity and Internal Medicine, based at BWH.
Walton also has literally raised a new building, constructed with local unskilled workers and staffed mostly with Haitian physicians and health staff, to serve the rapidly growing 350 to 450 outpatients every day, plus tripling the 15-bed inpatient capacity of the old clinic.