Congratulations to the MMSc-GHD Class of 2017!
MMSc-GHD Class of 2017
George "Archie" Ayeh, MBA, MMSc ‘17
rchie Ayeh, born in Ghana, has worked in Lesotho with Partners In Health (PIH) since 2006. As the non-clinical lead of PIH Lesotho, he supports operations at eight health facilities with more than 200 staff throughout the country, including remote rural clinics and the national MDR-TB hospital. Archie’s work touches all aspects of health care delivery, from financial management to logistics to facilitating strategic partnerships with local communities, national government, and other stakeholders. On any given day he might be arranging for the evacuation of an emergency case from mountain clinic to hospital by helicopter, or representing PIH Lesotho at meetings with UN agencies. Most recently, Archie played a key role in working with the Lesotho Ministry of Health to restructure the public health care system and expand the PIH model of care nationally. You can read more about Archie here.
Research site: Lesotho
Mentors: Joia S. Mukherjee, MD, MPH; Mary Kay Smith-Fawzi, ScD; Anjali Sastry, PhD
Study title: The Role of Community Health Workers in accessing quality PMTCT care in Lesotho
The Government of Lesotho (GOL) spends $295 per capita on health and yet the health outcomes are poor. Lack of trained health workers hamper the health system. Partners In Health, an NGO operating in Lesotho, has used Community Health Workers (CHWs) to successfully implement MDR-TB interventions and Maternal Health programs. The GOL has a Community Health Worker (CHW) program that could also be effectively utilized to address some of the human resource gaps. This retrospective cohort study compared the effectiveness of PIH and government-run CHW programs for Prevention of Mother to Child HIV/AIDs (PMTCT) services in Lesotho.
Jude Beauchamp, MD, MMSc ‘17
Jude Beauchamp is a Haitian physician who works with Zanmi Lasante/Partners In Health (ZL/PIH), helping to bring quality health care services to people in need in remote and isolated areas in the central plateau of Haiti. He started as a primary
are physician in the outpatient clinic providing general care and organizing community outreach activities like mobile clinics to reach those living far from health facilities. Due to his enthusiasm, he was promoted to direct the TB/MDR-TB program in Cange Hospital with ZL, where he provided holistic care to both inpatients and outpatients. He implemented a program for active screening and contact tracing of TB and MDR-TB patients and assisting in HIV and other infectious disease services, and supported the National Tuberculosis Program of the Ministry of Health (MOH) through trainings of health care providers from across Haiti in TB and MDR-TB care. His interest in both innovation and research to improve the quality of care led him to incorporate interventions to the TB program. One of these interventions resulted in a 50% increase in the TB screening of persons living with HIV/AIDS (PLWHA) coming to clinics in Cange Hospital. For his MMSc-GHD research, he seeks to examine how nutritional and socio-economic support can improve compliance and outcomes (e.g. time to conversion) and decrease sequelae (e.g. total deafness, psychosis) among hospitalized MDR-TB patients.
Research site: Haiti
Mentors: Carole Mitnick, ScD; Fernet Leandre, MD, MMSc ‘14
Study Title: Social and economic factors leading to delayed diagnosis of multidrug resistant tuberculosis (MDR-TB) and affecting success of ambulatory treatment in rural Haiti
Abstract: Patients with MDR-TB in Haiti face social barriers that may delay their treatment initiation and impact their ability to continue with the treatment. Understanding those factors can help to a more comprehensive and successful treatment approach. We conducted a mixed method study at two MDR-TB facilities in rural Haiti to inquiry on factors impacting the MDR-TB treatment initiation and continuation. We interviewed 17 patients twice, and 16 family members, and two medical care providers, we collected bio-medical data from those patients’ charts. A preliminary analysis of the data suggests economic, demographic geographical and structural (health system) are the main barriers identified.
Valeria Macias, MD, MMSc ‘17
In 2012, Valeria Macias began working as a general practitioner in the Sierra of Chiapas while doing her social service year with the program ofCompañeros en Salud Mexico (CES), a sister organization of Partners In Health in Mexico. While working there, she recognized the need of a referral system for patients to be able to receive secondary and tertiary care levels of health care. Two years ago CES hired Valeria to create and manage the “Right to Health Care Program.” This experience allowed her to learn how to navigate the health care system and how to help patients receive the medical care they need. For the first time patients in the Sierra of Chiapas can access high specialty care such as surgery and oncology treatment. During her MMSc-GHD, she continued researching the barriers in the health care system that prevent patients from receiving care, and her thesis recommended solutions to strengthen the referral system in Chiapas.
Research site: Mexico
Mentors: Mary Jo Good, PhD; Arlene Katz, EdD; Ryan McBain, ScD, MPH
Study Title: Rethinking referral systems in rural Chiapas: a mixed methods study
The research will explore the barriers for patients with Seguro Popular health insurance in Chiapas, Mexico. Specifically, we studied the referral process and its effects on care seeking. We used a mixed-methods approach to understand the patients’ experience when navigating the health care system and the health care workers’ perspective of the process. We reviewed patients’ records to gather quantitative data, and gathered qualitative data through interviews with patients and providers. Results will inform a new referral model that is replicable and
sustainable for the Mexican health care context.
Evrard Nahimana, MD, MMSc ‘17
Evrard Nahimana most recently served as district clinical director for Partners In Health Rwanda, an international organization working with the Rwandan ministry of health. After receiving his medical doctor degree as general practitioner from National University of Rwanda in 2008, he served for three years as a clinician with an interest in pediatric and newborn care in rural hospitals in Rwanda. Evrard spent the last four years working with the Ministry of Health (MoH) to strengthen the health system in Kirehe District, one of the rural districts in Rwanda. He also worked with the MoH to design and implement two ambitious and innovative initiatives: 1) the “All Babies Count” (ABC) Initiative designed to eliminate preventable neonatal deaths through health system strengthening in two rural districts serving 500,000 individuals; 2) the “Race to the Top” (RTT) initiative, a new district-based approach to performance based incentives, which strengthens processes and outcomes through community and health care worker engagement and through setting priority targets and offering peer-to-peer learning to accelerate change in care delivery.
Research site: Rwanda
Mentors: Lisa Hirschhorn, MD, MPH, Bethany Hedt –Gauthier PHD, Hannah Gilbert PHD, Hema Magge MD, MSc, Christina Lively, MEd
Study Title: Sustainability assessment of a newborn program in Rural Rwanda: A mixed methods study
Summary of project:
Over the past decade, Rwanda, a land-locked country located in Eastern Africa, has made substantial progress in improving and strengthening maternal and child health. However, the Rwandan experience has been similar to that of other resource-limited countries: while there has been a decrease in maternal and child death, neonatal deaths remain stubbornly and unacceptably high. All Babies Count (ABC) is an initiative that has been implemented in 2 districts in rural Rwanda targeting reducing preventable neonatal deaths and increase health-system capacity across the continuum of neonatal care. ABC has used evidence based approach through training, mentorship and district learning collaboratives to build healthcare workers’ leadership in data utilization for continuous quality improvement. Using a mixed method approach, this study aims to evaluate sustainability of improvements in neonatal quality of care, coverage and outcomes 12 months after the conclusion of the intensive phase of ABC program in two rural districts in Rwanda.
Kumar Rana, MMSc ‘17
Enrique Valdespino Serrato, MD, MMSc ‘17
Enrique joined Compañeros en Salud Mexico (CES), a sister organization of Partners in Health (PIH), after he completed his medical training. During his graduate social service year, he served as the only medical doctor for a rural community in the mountains of Chiapas. In this rural community (Reforma),he collaborated with the Ministry of Health (MoH) serving as the Community Health Center Director. There he ensured delivery of public health initiatives and high quality medical service. Most recently, he worked as the Regional Supervisor for CES to support primary care physicians in charge of rural clinics in non-accessible areas. In this role, he addressed challenges in regards to medical care delivery, clinic management, and community relations. He has also contributed academically to instruct medical doctors, nurses, and volunteers in Social Medicine and Global Health. For his MMSc-GHD project, he seeks to conduct research in health system strengthening through medical education to deliver high-value medical care.
Research site: Rural Chiapas, Mexico
Mentors: Mary-Jo DelVeccio Good, PhD; Molly Forrest Frank, ScD; Andrew Van Wieren, MD
Study Title: Understanding Mexico’s social service year from physicians’ perspectives: A mixed method study in rural Chiapas, Mexico
This thesis is about the clinical and social medicine experiences of social service year physicians in rural Chiapas, Mexico. Every year, the country deploys 8,000 medical students to increase health coverage in primary care clinics in rural areas as part of a mandatory community service year. These intern physicians solely staff about one-third of state clinics in Mexico during their last year of medical school, without another physician present for support or back-up. Conventional wisdom indicates that the students with highest grades and social status often select placements in more desirable areas close to cities. Others are sent remotely to work with few supplies, limited training in primary health care, and little or no mentorship or supervision. Absenteeism, demotivation, underperformance, fear and frustration are common features among the intern physicians or pasantes.
Martha Vega, MD
Martha is a Paul Farmer Global Surgery Research Associate at Harvard Medical School’s Program in Global Surgery and Social Change. Her current research work involves the study of surgical outcomes of mobile surgery in collaboration with the Cinterandes Foundation in Cuenca, Ecuador. In addition, she collaborates with the Lancet Commission on Global Surgery Health Delivery and Management working group by helping map the location of surgical facilities worldwide. Her aspirations include improving health outcomes and access to surgical care in rural communities around the world. Her particular interest is to research innovative surgical and health system strategies to provide high quality surgical and health care services to indigenous people from the Andes and Amazon regions. Martha was born in Lima, Peru and is a strong advocate for the health rights of underrepresented and marginalized people.
Research site: Ecuador
Mentors: Molly Franke, ScD; Robert Riviello, MD; Hannah Gilbert, PhD
Study Title: Access to surgical care in rural Ecuador and the role of Cinterandes mobile surgery in addressing barriers and delays: a biosocial analysis
Abstract: Globally, rural populations often cannot access surgery needed for their health and well-being. If they access surgery, rural populations often cannot afford the costs and face great risk of impoverishment after obtaining surgery. In Ecuador, no region-specific studies assessing surgical care access exist to date. Using a qualitative research approach, we investigated access to surgical care in the following rural communities: within Azuay and Cañar provinces in the Andean highlands; Morona-Santiago province in the Amazon region; and Santa Elena province in the Coastal region. In addition, we explored the surgical care delivery practices of the Ecuadorian mobile surgery program, the Cinterandes Foundation. We conducted 36 multi-vocal semi-structured interviews of patients, health care providers and health care and community leaders, as well as three brief ethnographic observations of Cinterandes patients and the Cinterandes mobile surgery program. Using a biosocial lens, we identified barriers and delays that limit the utilization of surgical care services by rural populations. We also described the role and impact of the Cinterandes mobile surgery program in rural communities. We found evidence that structural violence against rural and indigenous people limits access to surgical care. In addition, the interplay between historical events in Ecuador, social structures and human behavior have created habitus, a process embedded in the current surgical care delivery practices and patient’s care seeking behavior, which hinder timely access to surgical care. Understanding these social issues offers an opportunity to catalyze efforts to improve surgical care delivery.
Martha Vega graduated in November, 2017.
 Shrime MG, Dare AJ, Alkire BC, O’Neill K, Meara JG. Catastrophic Expenditure to Pay for Surgery: A Global
Estimate. The Lancet Global health. 2015;3(0 2):S38-S44. doi:10.1016/S2214-109X(15)70085-9.