Presenting at Global Diaspora Week at the US State Department

 

Moderated by Joseph Nwadiuko, the Executive Director of the Diaspora Health Network, the panel covered a wide variety of pathways of health systems strengthening, ranging from research, pharmaceutical capacity, humanitarian action and medical education.

 

The Panelists included: 

Dr. Neeraja Nagarajan, post-doctorate fellow at the Johns Hopkins School of Medicine and DHN 's director of research, discussed how DHN is building research capacity in developing countries. 

Dr. Bisrat Hailemeskel, Associate Professor of Pharmacy at Howard University, discussed his efforts to teach and support Ethiopia's pharmaceutical capacity, supported by the American International Health Alliance. 

Dr. Aelaf Worku, Hospitalist Scholar at the University of Chicago, discussed his work at improving processes and educating trainees in Ethiopia, supported by the American International Health Alliance

Dr. Bijay Acharya, Patient Safety and Quality Fellow at Massachusetts General Hospital, discussed his ongoing work with the America Nepal Medical Foundation in rebuilding the country after its recent earthquake.

All the speakers agreed on one thing: diaspora led work can--and must--empower local partners to lead change in their home countries. 

The Office of Global Health Diplomacy (S/GHD) guides diplomatic efforts to advance the United States' global health mission to improve and save lives and foster sustainability through a shared global responsibility.

Partner Posts: Kaplan October events

Kaplan has made amazing upgrades to all of our USMLE prep courses, which provide you with more options and more flexibility to prepare for the USMLE.  These upgrades make it easier for students to study and achieve their goals of matching to residency. 

You can reach out to us today and set up a complimentary appointment with one of our Medical Advisors who can create a personalized study plan for you.  In addition, we have great free workshops that are designed to ensure you are prepared to succeed on your exams and throughout your pathway to Residency.  Most notably, we have a Step 2 CS with Live Patient Encounter event on October 8th at 5pm and a sample lecture on the “Control of Eye Movements” by Dr. Stefan on October 15th at 5:30pm. 

Also, for anyone that comes to one of their Kaplan Medical Centers on October 31st can enter a raffle to win a High Yield or Question Based Integration Course (Value of $599).  To see all of the events we have coming up and to register please use the link below. 

CLICK HERE TO REGISTER

Do not forget to take advantage of their October SAVINGS.   Students can save 15% on Kaplan Medical courses through 10/31.  For more information and to discuss your studies send an email to –NYMEDADVISOR@KAPLAN.COM

 

Advocating for Diaspora in the Lancet

In a comment published in the September 6 issue of The Lancet, several leaders from the Diaspora Health Network made a compelling case for the inclusion of diaspora in humanitarian efforts.

"Diaspora health workers, irrespective of where they reside, are ideally poised to play a crucial role in the development of emergency response and health systems in their countries of origin. Members of the diaspora have close cultural and linguistic ties to those countries, which can create strong local grassroots partnerships that lead to a better understanding of the health needs of the population. Diaspora health workers have often had part or most of their medical training in developing countries, which means they might more readily adapt to local conditions and can provide culturally competent care. The well established professional, community, and familial networks that diaspora enjoy in their countries of origin also make them an unparalleled source for decoding local wisdom, power structures, and customs leading to the success of health programmes at the community level. Finally, they are self-motivated and often have a special interest in the long-term improvement of health care in their countries of origin, an asset that can be used to foster durable relationships that build on local capacity, " wrote Neeraja Nagarajan, Blair Smart, and Joseph Nwadiuko in the piece.

"There is an urgent need for all stakeholders—governments in LMICs and high-income countries, non-profit organisations, academic institutions, and development agencies—to create a blueprint that lays down clear strategies for the organisation, preparation, and engagement of diaspora health workers in health system strengthening and emergency preparedness. Diaspora health workers deserve an integrated platform and organised opportunities to develop meaningful, long-term, and sustainable engagements that improve health in LMICs, during times of crisis and beyond."

The Diaspora Health Network is working actively with groups, including with the American Nepal Medical Foundation to support capacity and build humanitarian response capacity both during and before crises. You can read the piece here (gate passable by free login). 

 

Our Work: Diaspora-Led Research Seminar in Chennai, India

 

DHN, along with Sri Ramachandra University  (SRU) recently organized a two-day research seminar and workshop for postgraduate medical and dental students in the city of Chennai, India on the 18th and 19th of August 2015. 

The two-day seminar was focused on introducing young physicians early in training to the basics of biomedical research. Dr. Varshini Varadaraj and Dr. Neeraja Nagarajan, both alumni of SRU and currently postdoctoral fellows at Johns Hopkins University School of Medicine, conducted the seminar. Dr. Sunil Solomon (SRU and Johns Hopkins alumnus and currently Assistant Professor at Johns Hopkins) and Dr. Eric Schneider (faculty at the Center for Surgery and Public Health, Brigham and Women's Hospital) attended the seminar.  The Dean of Research at SRU, the Dean of Faculties and other prominent faculty members, inaugurated the event. 

A total of 62 students participated in the seminar, with a mix of clinical and basic science postgraduate medical/dental students (resident physicians), as well as students pursuing a dual MD-PhD. The seminar consisted of talks on important areas of research, video presentations from faculty at Johns Hopkins, panel discussions with faculty from SRU and guest speakers, as well as a hands-on workshop where the students worked in teams to formulate a research question and present a proposal. 



A pre and post-seminar survey was conducted to assess the impact of the seminar as well as identify areas to concentrate on for further seminars. DHN will be conducting follow-up seminars and workshops in SRU and other medical institutions in India, Nepal and other countries to help develop local research capacity.

Diaspora Stories: Starting a Medical School in India

We talk a lot about sustainability, equity, and capacity building at DHN. That's because we understand that it's not enough to simply send diaspora back to their home countries; what they build has to create deep-seated change that outlasts them. At the same time, we understand just how hard it is to set up that sort of lasting endeavor in a low-income country. That's why it was so exciting to meet Dr. Sudhakar Pesara “P.S.” Reddy, a cardiologist whose passion for India spurred him to found a thriving hospital, medical school, and a large-scale community health project. 

Dr. Reddy grew up and attended medical school in Hyderabad, in south-central India, and obtained Membership of Royal College of Physicians (Edinburgh). He wanted even further training afterwards, and with the help of a friend he applied to the University of Pittsburgh, where he was immediately offered a Chief Resident position. He was hesitant to accept that much responsibility immediately (initially declining it) but eventually agreed to complete a year of residency and then become a Chief at Montefiore Hospital in Pittsburgh. He went on to complete a cardiology fellowship at Presbyterian Hospital across the street.

He joined the faculty after completing his fellowship and became the director of the cardiac catherization lab at (what is now known as) UPMC Presbyterian for 24 years. At one point during his tenure he was able to bring a family friend with a congenital heart defect to the hospital for an operation. However, he became increasingly aware of the cardiac need in his home city of Hyderabad, a city of seven million in a country known to have increasing levels of cardiovascular disease, which still did not have an advanced cardiac center.

Not long after he began investigating potential opportunities to address this issue, he also began to tune in to the pressing need for research capacity among India’s medical schools. In our interview, he hearkened back to his first research opportunity here in the United States. He frequently encountered patients with anemia and rheumatoid arthritis, which he had seen treated with an iron infusion in Edinburgh; however, he was unaware of there was any evidence backing that approach. So he went to the library one night, borrowed out a stack of articles on the topics (it was the '60s) and convinced his preceptor to run a small trial to see whether the treatment really improved outcomes.

Things didn't turn out as planned: the first three patients they trialed had their arthritis get worse, and they had to end the study after treating 7 patients. The results still enabled him to produce a paper on it in a major journal, an experience which still affected him deeply. 

"Here I come, and the very first week and I become a researcher!" he told us. "Meanwhile some individuals go through their whole life without being exposed to research.  I said to myself: one day I'll see that medical education in India has a research component."

He first tried to work with government hospitals in the region, but he was unable to make much progress-- as he explained, "they were so set in their ways; in the host vs graft reaction, host won, graft was rejected."  So he decided to start an institution of his own. He contacted alumni of his medical school and raised $250,000 to start the Science Health Allied Research and Education (SHARE). He reached out to both federal and state level government leaders (including the minister of science of technology) to help facilitate the details of incorporation. That's he encountered the first of many challenges in this journey: the huge expense of starting a hospital. He had to up the ante on his networking skills. 

“What you perceive as the need doesn’t count—it’s what local people perceive.”

"The chief minister of Andhra Pradesh our state came to the US for a kidney transplant. So I met him. He asked me, 'what are you doing?'  I said 'I am starting a hospital, I have land and some money but no government help.' He said 'what do you need?' So I took him to Chicago to a meeting of donors. I told him that while I have land I don’t have roads, I don’t have electricity, I don’t have a telephone line. I need permission to run a lottery to raise the money. He said 'I don’t usually do this, but irrespective of the cost, I will give whatever this doctor asked.'"

"I was able to raise 1,000,000, which I used to start building, but the money ran out. I went to financial institutions for loan which refused to consider our application because I was a nonprofit—but I was running like a business!  I recruited the recently retired Chairman of Reserve Bank of India to become the chairman of SHARE. Of course, with his credibility, banks gave me a loan for ~10 million Rupees."

Ten years later, the 150-bed Mediciti Hospital was finally built, initially to serve only cardiac patients; this was followed by the construction of another city within Hyderabad--Mediciti City Center. Mediciti Hospital was eventually expanded to a medical school--MediCiti Institute of Medical Sciences--that is now 14 years old and graduates 150 students each year.  The hospital now has 800 beds and covers a panel of 500 outpatients daily. 

 Mediciti Institute of Medical Sciences sits on 200 acres in Hyderabad, India

Mediciti Institute of Medical Sciences sits on 200 acres in Hyderabad, India

As successful as that was, it soon was evident that even building a hospital and a medical school wasn't enough.

One day, his donors posed a challenge to him: his brand new hospital and medical school were doing relatively little for patients in surrounding villages. They suggested that he take on family planning and immunization, which were both underutilized in the region (the vaccination level at that time was estimated to be about 50%). He decided to accept the challenge, starting with a pilot in a village on Hyderabad's outskirts. He approached a nun heading St. Theresa Hospital in Hyderabad for assistance. Her first piece of advice was telling:

"First thing, you have to have a doctor. And don’t mention family planning--if they have a stomach ache or headache, they should be able to get treated. That’s how you bring confidence." 

As a testament to their work, the 12-23 month immunization rate has risen from 43% to 98% across the village cluster; the total fertility rate dropped to 1.8.

A doctor and nurse were hired for the village and an assessment survey was conducted to identify all children below 5 years, pregnant women and women with two children or more and to determine need for tubal ligation procedures (the most common method of contraception in India) and vaccinations. Women were invited to have the procedure in a specially designated facility, and were allowed same day discharge to home with home care nursing support (a step up from government facilities which required a five-day post-op stay in the hospital).

There were setbacks: at first local officials were unwilling to partner in Reddy's efforts or provide the subsidy that it traditionally gave to patients in its hospitals. However, more patients were attracted to the shortened stay that Dr. Reddy's operating suite permitted, and as attendance grew, the government eventually came on board.  (The vaccination program had it’s own share of challenges related to low staffing and supplies within the existing national infrastructure program, requiring Dr. Reddy to invest in auxiliary staffing, transportation and cold chain storage to enhance delivery.)

Nonetheless, he eventually achieved 100% immunization coverage in the first village, and then went to take on several more villages until the Rural Effective Affordable Comprehensive Project (REACH) covered 40 villages across Andhra Pradesh. A community health volunteer program was set up to surveill marriages and births in each village so that immunizations and family planning could be continually available.  As a testament to their work, the 12-23 month immunization rate has risen from 43% to 98% across the village cluster; the total fertility rate dropped to 1.8. (Here are some published results from their efforts.)

Though he is partially retired from practice, he remains involved in capacity building and academic training in India, as well as mentoring the Longitudinal Family Health Study (patterned on the US’s National Children Study) and the Mobility and Independent Living in the Elderly study (MILES), both based in India. (In the middle of all this, he still makes time to spend part of each year to do clinical work and teach at the University of Pittsburgh.) Achieving research capacity in India’s medical colleges remains an important motivation for his work, a process that he feels is iterative, sometimes requiring the repeated instillation of basic skills. Most importantly, it requires strong local leaders as partners: 

"Someone locally has to have passion, and even power. Passion without power is useless. In India and China and the Middle East, [the medical establishment] is very hierarchical, and [leaders] can feel threatened if someone junior goes ahead of them. Only the guy in charge of the department can allow the research to be done in the department."

However, was clear to him that any individual in the diaspora wanting to make social change at home, your own passion is paramount for success:

"There are bricks all around you, but there needs to be a cementing force," he told us. "I am just a cementing force, there are bricks who make the building. To lead one has to be prepared to play the role of ‘One’, then many others volunteer as zeros and the organization grows and becomes mightier with addition of each zero [—until you become 1,000,000’s].  A lot of passion and sacrifice is necessary, and even family has to be willing to bear the cost."

At the end of the day, Dr. Reddy is successful because understands the importance of being locally driven. He takes to heart the words of the village nun who helped set him off on his journey to improve public health:

"What you perceive as the need doesn't count--it’s what local people perceive."

 

 

 

Diaspora Stories: Combating Infectious Disease in the Philippines

A couple of months ago, we had the privilege of learning about Dr. Juan Puyana's work to reduce trauma in Colombia by collaborating with trauma surgeons there. 

We're going to continue this series of interviewing active diaspora, and below Dr. Bernard Macantagay (Assistant Professor of Medicine at the University of Pittsburgh) shares a similar tale of how he was able to establish academic partnership with the University of the Phillippines to help strengthen research capacity in infectious disease. We're accepting submissions! If you know of any other active diaspora that we can profile (including yourself), by all means email us at diasporahealthnetwork@gmail.com. 

On how it all started.

I was born and raised in the Philippines and completed medical school in the Philippines. I always knew I wanted to get into ID, even before medical school. In medical school during my free electives I did parasitology, and after medical school I didn’t go straight to residency. I actually did field parasitology with Dr. Belizario, who is a professor there of parasitology, and who eventually became deputy director and director of the NIH of the Philippines.

He was an amazing mentor, and I did a lot of work with him going to the field, doing deworming kids and looking at poop to see if they’re infected or not. Then after one and half years or decided that I’ll go to residency so applied here in the US. When I got here, I fell in love with HIV. My mentor at that time, Gail Skowron, is an HIV immunologist and has an HIV clinic. She recommended that I apply to Pitt. This was my first interview and I fell in love with the program and so I ranked it first and was lucky enough that they ranked me! I did two years of general ID and two years of HIV/AIDS fellowship here.

I think the important thing is to get people high up in both institutions.
— On forging academic partnerships

When I was a second year fellow, I found out that Dr. Bellazario frequently travels to the US as a consultant for the WHO in the Philippines and the Western Pacific Region. [When] he said he was coming to the US, I asked, “Why don’t you come to Pittsburgh and talk about tropical medicine? We don’t get to see a lot of tropical medicine and I think the fellows will have a great time.” And he came to Pitt and said, “I don’t want to just visit and give talks; there should be something that comes out of this.” We discussed all this in 2007, [and] in 2008 [Associate Vice Chancellor for Academic Affairs] Maggie McDonald and [Associate Dean for Global Health] Peter Veldkamp went to the Philippines and the 1st MOU was signed between Pitt and the University of the Philippines. And since 2008, we’ve had medical students and pharmacy students and GSPH students going there to do research. We’ve also had medicine residents and an ID fellow going there.

Edsel Salvaña, my classmate in medical school who trained at Case Western and is now back in the Philippines, comes to Pitt and teaches Tropical Medicine here, because we made him Adjunct Faculty. Pitt and the University of the Philippines had had several publications together. Moving forward we want to have a lot more ID fellows from the Philippines coming here to do part of their training.

The thing is, just right about this time the cases of HIV in the Philippines just started skyrocketing. In the 80-2000’s the cases of HIV in the Philippines was very low and then it was growing--exponentially. Why? People are trying to study all these things. Initially it started with call centers but now the number of cases that we’re seeing monthly is so high. Pitt may be able to help try to control that by helping to train more people from there to do epidemiology research, and now that I have my own lab, to train them with some immunology research.

We currently have three students who are going to the Philippines this year. And we are going to try to get some more medical students from there to come (to Pittsburgh). Actually one of the Edsel’s research assistants is a PhD candidate here now. Our plan is to have more trainees in research here to give them additional training in immunology and virology so that they can apply this knowledge in the Philippines.

What are the specific projects that have come out?

So a lot of these projects have been parasitology projects. The worm burden in public schools right outside Manila is about 80%, and it affects the children’s school performance. We have our medical students trying to go out into the community and figure out the factors associated with this so that we can do interventions. The year before, they did a study on pregnant women. We’re trying to formalize more collaboration in HIV research. And hopefully (our PhD student) could go back to bring some of the technology here over there. We’re hoping to get more people to train in epidemiology here (since Pitt is part of the Multicenter AIDS Cohort Study with Northwestern, Hopkins, and UCLA) so that they learn from our experience with the MACS and go back to do something similar over there.

How do you overcome the kinks?

Remember the people we’re collaborating with there are very, very busy. They carry a lot of responsibilities. Although there is research, the infrastructure is not as developed as what we have here. The doctors who are interested in research will also have to earn a living by doing clinical work. They work in the Philippines General Hospital, which is a public hospital, and they have to have their own private practice. They have to juggle all these different things to make a living and to push research forward. Any time Peter [Veldkamp] and I are there or when they’re here, we maximize on those times to discuss projects and to get the process started. Because sometimes, when you send an email, it’s just really hard to get follow-through with all the work we’re doing here and they’re doing there.

I think the important thing is to get people high up in both institutions. Because if it weren’t for someone like Dr. Belizario and Peter (Veldkamp) and Maggie McDonald, I don’t think things would go where they’re going now, because (Edsel and I) were just ID fellows when we started the collaboration. Now, we just continue to renew our MOU.

Any other dreams you have?

To get a grant where we have a PI both here and there, and to be able to start a cohort and do treatment and prevention studies in the Philippines. Also, to get more people from the Philippines to do additional training here in HIV research.

On his medical education in the Philippines and his motivations for continuing this work.

Since the government paid for a great majority of our tuition in medical school, I believe that it’s our duty to be able to give back…and that’s one of the things I always keep in the back of my head as to why I keep on doing this because [the government] really helped me out. Also my dad’s a doctor and he was the Chairman of our barangay [village; several villages make up the town/city], and because of that, my sister and I were considered barangay scholars, so we paid even less. I think in the first two years of medical school I was paying about $3 a semester. And it’s the premier medical school in the Philippines.  You don’t forget something like that, and so this collaboration has to continue to go on.