Boston Children’s role in the Global Health Delivery Partnership

By Kim Wilson, MD, MPH, associate director of the Global Pediatrics Program.

For most children in the United States, seeing a pediatrician is an annual event. For other children, especially those with more complex problems, visits to pediatric subspecialists are common. But in many parts of the world seeing any type of doctor, pediatric specialist or not, is simply impossible.

Ever year eight million children die in developing nations where there are few or no doctors and nurses trained in pediatric care. What’s worse, many of these deaths are preventable. Public health initiatives that increase access to clean water and improve nutrition have done much to contain these numbers, but more needs to be done to provide quality health care to children all over the world.

As Paul Farmer, MD, founder of Partners in Health (PIH) and Chair of Global Health and Social Medicine at Harvard Medical School, recently stated, the clinical expertise we have at Boston Children’s Hospital can have a profound affect in achieving this goal. And I’m proud to say that our physicians and nurses have taken on this challenge, with global health activities happening in over 160 different sites, including ongoing programs in Haiti, Rwanda, Liberia, Ghana and Uganda.

Kim Wilson, MD, MPH

To better support these efforts Boston Children’s has joined with Harvard Medical School, Partners in Health (PIH) and the Brigham and Women’s Hospital in the Global Health Delivery Partnership, a collaboration committed to improving health care delivery in the most resource-limited regions of the globe.

Each site has different programs and utilizes different techniques based on need, but the theme of training is a cornerstone of every project. Examples include:

Rwanda: Anne Hansen, MD, MPH and Michelle LaBreque, RN, from Boston Children’s Division of Newborn Medicine, are working with the Rwanda Ministry of Health and PIH to develop and implement national guidelines for care of ill newborns, focusing on simple, appropriate interventions like keeping small babies warm and giving them appropriate amounts of fluid and antibiotics.

Hema Magge, MD, from the Division of General Pediatrics, is making great strides at the community level, training primary level health providers in Rwanda to improve primary care services for children.

Boston Children’s Department of Medicine and Department of Anesthesia is about to play a leading role in the Rwanda Human Resource for Health initiative. It’s an ambitious multi-university collaborative that will dramatically expand residency and medical school training in Rwanda. In pediatrics alone the program will increase the number of pediatricians from about 15 to 70 over the next seven years.

Haiti: Over 200 Children’s staff volunteered in Haiti in the period following the 2010 earthquake and these collaboration continue with Boston Children’s Plastic Surgeon-in-Chief John Meara, MD, and Sad Sayeed, MD, leading ongoing work in Surgery and Neonatology. Chris Carpenter, MD, of Boston Children’s Global Pediatrics Program (GPP), recently met Ibenson, a 2-year-old dying from severe malnutrition while working in Haiti. Nobody expected him to survive, but thanks to implementation of an inpatient malnutrition protocol Ibenson survived and is now thriving. But for many in Haiti, improving care is far more complex than changing a protocol or two. Fortunately a soon-to-be-opened PIH-affiliated tertiary care hospital in the central plateau in Haiti will be available to support collaborations on more complex surgical and specialty care.

Liberia: In a country where 10 percent of population dies by the age of 5, the need for pediatric expertise in Liberia is dire. Fortunately Michelle Niescierenko, MD, and others are working with a consortium of U.S. university partners at JKF Hospital in Liberia’s capital city of Monrovia to improve pediatric and surgical care for children. Rotating pediatric faculty, residents and global surgery fellows help train medical students and general physicians in providing acute care for hospitalized children, and improving outpatient care for children with chronic illness. The program will soon expand, with new surgical and anesthesia initiatives and additional support from pediatric specialists.

Other examples of exemplary work include the Dana Farber/Children’s Hospital Cancer Center, which has forged partnerships across the global to improve care for children with cancer. Alejandro Gutierrez, MD, Lisa Morrissey, RN, and Jorge Fernandez, LICSW have partnered in Bogota, Columbia on a twinning program for pediatric cancer care. Sara Stulac, MD, and Leslie Lehmann, MD, are working with Partners in Health to build pediatric oncology programs in Rwanda.

Chris Carpenter, MD, and patient

Programs using technology to provide training and consultation to medical professionals in remote areas are being developed here at Boston Children’s, and have the potential to dramatically improve ICU care, Urologic care and Cardiac care all over the world. Ongoing collaborations in Cardiac Surgery in Ghana, and in Neurosurgery in Uganda offer children in these regions new access to life saving procedures.

While the needs remain great and the solutions may seem complex, what we’ve learned is that we, as individuals and as an institution, can—and will—make a profound difference in improving the health of children worldwide.