Project Title: Barriers and facilitators to timely diagnosis of childhood tuberculosis in Karachi, Pakistan
Project Location: Pakistan

By Christina Lively 

I spoke to Sara Ahmad, BDS, MBA in September. She called in from Pakistan, where she is completing her thesis project on improving TB care for children. Sara is a thoughtful person who is dedicated to making a positive impact. She described how she got into her work on TB by describing moments of inspiration on her career path. Her eyes lit up as she told me about these moments, and as she told me the story behind the project postcard from the field that she sent along as part of the thesis. 

 

What did you do before joining the MMSc-GHD program?

It has been a journey. I did my undergrad degree in dentistry, but while I was in dental school I did not feel very inspired. I felt it was quite limited to 1:1 patient interaction and I wanted to work on problems in a more holistic way. I had seen my dad work with underprivileged communities, and I had grown up with the desire to do more - make a bigger impact. 

Therefore, I switched to public health and enrolled in a master's in health and hospital management program. I really enjoyed learning aspects of healthcare that we were not taught in dental school, and this opened up my world to new possibilities. I learned how to design and manage hospitals, supply chains, human resources, and pharmacies - as well as how to engage with communities. I simultaneously joined the TB Reach 3 project and found that I enjoyed leading teams and learning how to navigate discussions with relevant stakeholders, with the end goal of helping more poor patients get access to quality healthcare. When I started working on TB Reach 3, I said to myself, “This is what I want to do.” 

What made you decide to get to join or to apply for the MMSc-GHD  program?

Getting accepted for GHDI (Global Health Delivery Intensive) in 2016 was a huge turning point for me because that's when I interacted with Joia Mukherjee (MMSc-GHD Program Director) and took her course. The passion with which Joia spoke about several health issues (including TB, of course) afflicting low-income countries and the reasons behind their prevalence was very inspirational for me. I realized that there is so much work that needs to be done, and a lot more analysis is required to understand how to move forward with more effective models - healthcare will continue to remain inaccessible to those without resources.

When I went back after GHDI, I had an inkling that I wanted to study this further. I applied to several public health programs and got accepted to most of them, but then suddenly I learned about the MMSc-GHD program and applied for it. I wish I had known about the program earlier because I definitely would have liked to join the program sooner. 

 The program is much more than a public health curriculum because an MPH is general, whereas the MMSc-GHD program is more focused on what I have experience in i.e. implementing health interventions in resource-limited settings. When I read about it on the website I knew right away, that "This program is exactly what I want to do.”

Students write a “postcard from the field” each month during their project. I have your most recent one here. It is great! Can you tell us about the photo of the people in the boat? 

Glad you liked it! I traveled with this team on a trip to an island (called Baba Island) where the inhabitants are mostly fishermen. Three months of every year there aren’t any fish, and even when they do catch fish there is not much revenue, so they are very poor. Before Indus Hospital's clinic set up, there was hardly any health care available for TB patients on the island.

I ended up interviewing a family that lived there. They had three children. One daughter who is seven years old, along with her mother and paternal grandfather, were all on Drug Resistant TB treatment. Both parents seemed quite worried for their children as one their only son had passed away earlier this year because of TB. The father of the children  knew Owais, one of the health workers on our team, and only trusted him for his family's care. The father contacted Owais when his daughter fell sick,  and told him that  he would come to whichever hospital Owais was working at, to make sure the rest of his  family stays alive. And therefore, this strong rapport between the patient’s family and our health care provider resulted in three patients being started on treatment on time, as well as making sure that any side effects from the medicines stayed well managed and the patients stayed on treatment. A doctor (not photographed) had accompanied us on this trip as it was time for the monthly follow-up, and it would have been too costly and cumbersome for the family to travel to the hospital for it.

As you can see the treatment support team has been doing amazing work. I feel like these are the real unsung heroes because without them poor patients would not know where to go when they fall sick with TB, nor how to continue treatment to the point of completion. The kind of moral support and help that these health workers provide day in and day out makes me feel that there is still some goodness in the world, and that systems run well solely because of such people's dedication. 

What is your advice for first year students? 

I would say, keep your focus. It's challenging to do that because you're new in the country and there are many distractions in getting settled in, but it does get sorted out. Form a good study group and make sure that you do your readings every day, because that way you would be on top of your studies. Also, keep the goal in mind and your area of interest, so that you can enroll in the related electives. It seems like a long time but it passes by very quickly, and it is important to make the most of it. But do have fun, network, attend events, explore new hobbies (I loved dancing at the Harvard Dance Club!), and take advantage of being a student - there is a lot on offer and one should avail those opportunities. 

What advice would you give prospective students?

It can be intimidating to move to a new country alone, but once you get over the initial hump, it gets easier with time. There is a lot of support from everyone and many facilities are available to ease the process. Also, start thinking about what you want to do your thesis on and start reading up on literature, because that would save you a lot of time. Shortlist the topics you find interesting and focus on them so you have a good idea when you get here. And reach out to your seniors before coming - mine were very helpful and that got me through many hurdles. 

This interview has been edited and condensed.

​ Project Title: Routine vaccines in the COVID-19 era: A mixed-method study exploring parents’ perceptions in Haiti and USA, 2022
Project Location: Haiti/Massachusetts

By Bailey Merlin 

Vanessa Dor and I meet in a Zoom room on a gorgeous February morning right before another violent cold snap rocks New England. We joke about not knowing how to dress for such a temperature rollercoaster. She’s been sorting through her project’s data for weeks, yet she looks well-rested. Things move quickly later in the spring. T.S. Eliot was right, April is the cruelest month. It is good, however, to hear from this Fulbright scholar and all-around superstar about her project now that graduation looms large.  

For context, Vanessa is a compassionate physician and epidemiologist who strongly focuses on children’s health and infectious diseases. She currently serves as the Head of Monitoring, Evaluation, and Research at Nos Petits Frères et Sœurs and as a Medical Coordinator at Saint-Damien Hospital in Haiti. Vanessa’s leadership skills are evident in her ability to lead outbreak investigations and surveillance system evaluations. Her commitment to education and mentoring is also noteworthy, as she has fulfilled teaching and mentoring roles with the Field Epidemiology Training Program-Haiti as a Mentor and Communication Training Facilitator. She continues inspiring and mentoring pediatric residents and medical and nursing school students. With her upcoming thesis defense on determinants of vaccine hesitancy in children, I was excited to learn about her project.  

It is unusual for Global Health Delivery students to do projects that straddle two countries, but not surprising in Vanessa’s case. Her project explored patients’ perceptions of COVID and political violence and how it impacts their vaccine decision-making. It was a large mixed-method study that surveyed 300 Haitian participants at 3 locations, 2 in Haiti and 1 in Boston. When I ask her why she wanted to pursue such an ambitious project, she tells me that it’s important to understand the differences between urban and rural areas so that providers can better understand the decision-making processes for parents.  

Given Vanessa’s passion for equity, I wanted to sit down and hear how the Global Health Delivery program has influenced her work. 

BAM: Given that you were already a pediatrician, what made you want to pursue a master’s degree?  

VJB: Being a pediatrician led me to epidemiology. While working as an epidemiologist as the head of the monitoring evaluation and research department, I quite often struggled to understand some constraints that we have internally in the institution that Affect our ability to provide the kind of care we need to do the research projects we wanted to explore. COVID was a great shock because I understood that so many external forces shape our ability as providers, medical coordinators, and hospital administrators to provide care. Because of COVID, we lost funding and had to cut services to women. I said, “Okay, I need to understand public health on a broader level.” So, I decided to apply for the Fulbright scholarship and to do my master’s degree. 

BAM: You mentioned public health. Why did you choose the MMSc-GHD program instead of an MPH (Master’s in Public Health)? 

VJB: That’s a good question. Ironically, I learned about the MMSc-GHD program one or two weeks before the end of the admission period. I had already worked with my Fulbright advisor on all my applications for MPH programs in the U.S. I thought I was done and that I received an email about the MMSc-GHD program, and as soon as I opened it and started to scroll through the website...It was a little bit shocking because the first thing I saw was the program’s research focus of the program, and I was so into research and wanted to have more knowledge about qualitative research. I remember—you know me with my little lists—going through the classes I would take. Qualitative research? Check. And then, I saw the social medicine aspects that shaped the whole program. As a pediatric resident, I was very concerned about the social aspects of medicine. I had so many questions, so many unanswered questions, about how social determinants affect the care we provide to our children and how we can actually improve the process. And I’m like, maybe it is the right place to answer those questions. And then the pictures. There was Paul Farmer worked with students on their thesis. I’m like, Paul Farmer? I knew this name because I remember reading an article about his work in Haiti and how he managed to bring HIV drugs to Haiti. At that point, I was sure there was no way I would get into the program. But I am here now. I’m glad that I sent my application in at the last minute. 

BAM: What has surprised you the most about the program? 

VJD: First of all it is that I am surprised about the kind of support that we have because, in my mind, when I was coming here, it was like a master’s program. You have your own like involvement. You have your own effort, you know, to achieve whatever you want. But we knew we were not alone from the very first day we arrived. The professors both teach us and help us practice. You feel supported all along. I was also surprised by the flexibility we have in shaping our curriculum. You can cross-register at MIT! But many of our classes were also surprising to me. I wanted to take a qualitative class, but ethnography was a big surprise. I knew ethnography existed, but I didn’t know what to expect. It was a very valuable experience because it’s been a lot of learning to be out of your comfort zone, which includes diving deep into someone else’s experiences. It was a very interesting process. 

BAM: Were there any challenges you faced while conducting this research? 

JVB: It was challenging because I have a big population in three different sites in two countries. That takes a lot of coordination. Some of the sites were especially challenging by themselves. For example, we had many plans: Plan A, Plan B, and Plan C in case something happened in the borderlands, and we could not work with that population in that population because of the situation in Haiti, especially in the urban areas, which were so unstable. One of the strategies I used was to start data collection in April [of year 1] instead of waiting for August just to be sure that I would have a lot of time to find my data because there was so much going on in Haiti. It’s important to understand the patient experience, particularly in Haiti. There was a kidnapping issue in the research hospital itself. And the strikes! Because of that, we had to stop data collection three times. At the end of the day, we got the job done and had some interesting experiences with the patients. They were so willing to share their experiences, so I’m very grateful for that, especially since many of them were undocumented or living in shelters. That part was hard because we had to convince these patients to trust us. Fortunately, my thesis committee was so involved all the time and so supportive.   

BAM: Who are your mentors? 

JVB: Serena Koning is my primary mentor, and I am working with Hannah Gilbert and Joia Mukherjee. 

BAM: How do you feel that the program prepared you for your research in a way you wouldn’t be able to do before joining the program? 

JVB: We have to write a paper to dive deeper into our country’s history, political economy, and health system. Working on that part before building my data collection materials was important because I love history. I read a lot about ancient history, but it was the first time I linked all the dots between this history and the political economy. This history, the failure of our healthcare system, and this perspective helped me shape my questionnaire, interview, and approach to the project. The qualitative class, of course, was crucial in helping me conduct the in-depth interviews because I had some quantitative background before joining the program but not much for the qualitative part. 

BAM: We just accepted the incoming Class of 2025, and I wonder what advice you have for prospective students. 

VJB: Enjoy every moment and every space in the program. On an academic level, don’t limit yourself. I remember one of our faculty once told me that you can never do enough here in this space. If you have an interesting idea, talk to the faculty about it. We have one of the largest libraries. There’s no limit! Use those resources because they are there for us. If you want a teaching fellow experience, go for it. I learned a lot from helping people on their journey. You also have an opportunity to talk to faculty on a personal level, too! Be confident and humble at the same time. Be confident enough to tell your true story. As an international student, you may feel your story is too different from accepting, but your perspective is needed! People will learn from you, and you will learn from them as well. Be humble because there is always something for you to learn. That’s why you’re going, right? Make the most of your time here, enjoy the process, and have fun. 

This interview has been edited and condensed.

 

Project Title: Evaluating the telehealth Kotak Dokter implementation for high-risk pregnant women in rural maternal care in Garut District, Indonesia
Project Location: Garut, Indonesia

By Bailey Merlin

Ana Mariana and I meet for a Zoom call at the end of October. Two minutes into our session, I discover Ana is already back from the field and taking classes in Boston. I reschedule our session for the following Monday when we can see each other face to face. We meet in the lobby of the 641 office, exchange warm welcomes, and then find a quiet spot to chat. It’s good to see her. What strikes me about Ana today, as it has in the past, is her outfit. Her hijab is typically some beauty, and today is no different. The black fabric gathers in a lace pattern at the front of her throat. If you’ll forgive me, it ties together the rest of her green monochromatic outfit.

Ana has been ready for this meeting for weeks, and as soon as we sit in a back office, she launches into her speech. It’s good to be around her enthusiasm again.

Ana’s research is about evaluating the implementation of Kotak Dokter, a telehealth platform for mobile, remote, and community-based healthcare workers that connects patients with primary healthcare physicians. She worked specifically with pregnant women seeking care in Garut District in Indonesia, which is in the small rural province of West Java (or Jawa Barat). Her three research questions are: How much do patients struggle to get to healthcare facilities? How do they feel about the implementation of Kotak Dokter? What are the barriers and facilitators to Kotak Dokter’s implementation?

She graduated in 2015 with her MD from the University of Jenderal Achmad Yani (UNJANI). She then moved on to deliver medical care in southern Indonesia. It was in these clinics that she got her first real taste of what global health means as a physician. That taste propelled her to become a research assistant for the OBGYN department in one of the largest hospitals in Indonesia (Dr. Cipto Mangunkusumo Hospital). This is where Ana’s interest in maternal care came into focus.

From there, Ana got busy. After her internship ended, she became the Clinical Operations Manager for Docta Indonesia, an international company that operated in Australia and Indonesia. The company worked with the government in West Java Province to implement the innovation of mobile clinics (MPUS) and the telehealth of Kotak Dokter at the primary health sector level, so the primary doctors in the Puskesmas (community health center) could be integrated with Pustu or Posyandu and communicate easily with the midwives/nurses or patients in the villages without additional charge. In theory, it was designed to solve the health disparities between urban and rural areas, strengthen health with digital health at the primary or community level, improve health outcomes, and strengthen trust and monitoring between healthcare providers and their patients. The reality, of course, was harder. “The problem is working with the government,” Ana tells me. “We cannot rely on a limited budget or grants.” Wanting to strengthen her own health system was what sparked her curiosity to look for programs that would mitigate this problem.

Before joining Harvard, she also had the opportunity to contribute to managing the COVID-19 pandemic in West Java Province as part of the accelerator team in managing COVID-19 in West Java Province, especially in the division of contact tracing. In the accelerator team of COVID-19, she ran an online contact tracing piloting program in Bandung Regency and Cimahi City. Her role as a volunteer coordinator is coordinating and attending coordination meetings with various related parties to formulate the best steps to do online contact tracing in the community.

We are only five minutes into our interview, and Ana is so impassioned that I have to pause, laugh, and tell her that we’re getting ahead of ourselves. I don’t want to miss a minute of this story.

BAM: You were very busy before joining the program, so I want to root into the why. Why Global Health Delivery?

AM: This is really personal because I remember when I was young, my grandmother died due to inadequate treatment and difficulty reaching the nearest rural hospital. At the time, I remembered that my grandmother needed specialized treatment, but there wasn’t a specialist at the rural hospital. She was referred to a different hospital that was over six hours away. She died in transit. That was the very beginning of my interest in global health. I don’t want any patients or families to have experiences like mine.

BAM: And why did you want to get your master’s degree from this program?

AM: I want to be an expert in global health and social medicine. This program was the first time I heard about global health in an educational setting. There’s nothing like this program that I found in Indonesia. Indonesia does not have a post-graduate or even a doctoral program related to global health. The MMSc-GHD offers me comprehensive knowledge, critical thinking, and a methodological approach specific to global health research. I will be able to use the tools that the program has given me to implement my research and benefit vulnerable populations.

BAM: Did you know any faculty before you came to the program? Did you know who Paul or Joia was?

AM: No…

We both get a good laugh out of this. In the spirit of full disclosure, I also had no idea who Paul Famer, Joia Mukherjee, Salmaan Keshavjee, and many other global health leaders were. We know better now, and our lives are richer for the experience.

BAM: Now that you’ve been in the program for over a year, what would you say has surprised you the most?

AM: That’s an interesting question. What surprised me the most was that my expectations were met. I got a lovely family through the MMSc-GHD, beautiful friends who always help me, and the best of the best teachers that give us both education and their field experience. I’ve learned a lot about accompaniment. I’ve learned to be a good listener, feel a patient’s pain, and understand a patient’s journey. I learned from Paul and Joia that you need to be ‘on the ground’ to understand the problems that patients face. When working as a doctor in rural areas, I didn’t understand why people didn’t want to go to the hospital. But then, after I learned a lot from this program and returned to Indonesia to conduct my research, I tried to implement everything I’d learned about ethnography, quantitative research, qualitative research, and the art of accompaniment.

BAM: Were there any classes that stood out in terms of helping you with your research?

AM: The ethnography class with Professor Byron. I loved that class. I didn’t have any experience with ethnography at all. The first assignment was to conduct an interview with one of my friends. I picked Raka [Dananjaya, another second-year MMSc-GHD student]. We talked for more than eight hours over three days! Through that course, it felt like I had known Raka for a decade. I learned so much from [Raka’s] pain, travels, and thoughts. It was such a benefit to me. It made me feel humble. I brought those lessons into the field. I would spend one hour with each patient to understand their experience. I am grateful to the ethnography class. Now, I will be able to use the tools that the program has given me in the MMSc-GHD to implement my research, to perform social and delivery science and policy research in resource-limited setting for the benefit vulnerable populations. MMSc-GHD program prepares me to situate global health work in its broad social, economic, and political contexts, where I need this knowledge to implement in Indonesia, especially in rural and remote areas.

BAM: It’s really good to hear the classroom translating into the field. Were there any challenges that you faced that you want to talk about?

AM: Because my research was on implementing telehealth, the biggest challenge I faced was the lack of internet access. Other than that, it was challenging to get to the field! It could take up to an hour to get from the community health center to patient houses…The way I went to every patient’s house, I felt the same problems they did when they went to the community health centers. What I heard [in my interviews] was that it was difficult to go to the Puskesmas (community health center). But what other choice do they have? They live in the mountains…I felt their difficulty in going to the nearest healthcare facility.

BAM: I can understand this as a significant barrier to care. Who is your primary mentor?

AM: Professor Byron Good.

BAM: And what did he say about these barriers? What advice did he have for you?

AM: When I told Byron I wanted to do this research, he was excited. I told him that this sort of implementation had never been done before in Indonesia. I hope that this project can give recommendations for future telehealth programs. He suggested that I spend a lot of time learning about midwives, community health workers, and patients. What are the biggest challenges they face? He recommended that I do the grassroots work of speaking with these people to better understand my project.

BAM: And what advice do you have for prospective students?

AM: Apply to this wonderful department. There are so many teaching faculty members who will give the best of themselves to support you and give you the best experience to help you develop the skills you need to be a leader in global health. I believe life gives us a chance to cultivate ourselves to benefit the wider community. The best thing I can give others is to be the best version of myself. For all prospective students, please give your best to yourself and the wider community. If you would like to be a global health leader in the future, the MMSc-GHD program is the best fit for you.

This interview has been edited and condensed.

Project Title: What is the Impact of Telemedicine (TM) on Access, Provider Experience, and Clinical Outcomes in the Context of the COVID-19 Pandemic in Colombia?
Project Location: Colombia (researching from Boston)

By Bailey Merlin

Susana Orrego Villegas, or “Susie” to her classmates, is a spot of sunshine, no matter the weather. Generous with her wide smile, it’s easy to feel, well, at ease with her. After sitting through Dr. Arthur Kleinman’s lecture in GenEd 1093, a class Susie TAs for, we walk to the Science Center on the Cambridge campus, not too far from the art museum where the class is. Susie knows her way around; that much is apparent as she snakes me through a reading room to find an empty study space. She checks the reservation schedule on the door and tells me, “We’ll move if they show up.”

Susie is confident, and I like that about her.

Confidence has been a theme of this Colombian physician’s life. Before joining the program in 2021, she worked as a leader in Seguros SURA in Colombia. Along with her team, Susie analyzed patient records to understand health care needs and design models for certain populations. As I pull out my notebook and pens to prepare for our interview, she casually tells me about the adult and pediatric palliative care programs she helped design and implement back home in Colombia. I laugh as I scramble to turn on my recorder, but she’s happy to repeat every word.

Susie is kind, and I like that about her, too.

To contextualize her project, Susie tells me that Colombia has had national health insurance coverage since 1993. The basics are: the government takes 12.5% directly out of your wages and pushes it into the healthcare system. Your healthcare is free if you live on the poverty line or have a chronic illness or disability. Despite public health insurance, private insurance is available for those who can afford it. Private insurance allows access to shorter wait times and, pre-COVID, gave holders access to telemedicine. Telemedicine here is more convenient than visiting a health care center for non-urgent medical concerns. For all intents and purposes, telemedicine was for a small part of the population.

But after COVID-19 landed in Colombia, telemedicine was the primary resource Colombians had to access care. For those who don’t know, like me, Colombia had one of the strictest lockdowns in South America. Susie told me, “We were four or five months on lockdown, which completely changed the paradigm about telemedicine.” No longer was telemedicine for those who could afford the convenience of private insurance; it became a public necessity.

What Susie wants to know now, and what she’s researching for her thesis project, is what the impact of telemedicine during the pandemic was. She plans to find out if the demographic for those seeking care via telemedicine has shifted from the city to more rural areas in Colombia, where receiving care is more difficult.

As she tells me all this, her eyes fill with a certain fire that confirms my suspicion: Susie cares about the populations she serves.

BAM: It seems like you had your hands full in Colombia. What made you want to put your career on pause and pursue the Global Health Delivery program?

SOV: I’ve always had a curiosity. I already have a healthcare administration degree, but I was wondering what I could find abroad. What are other perspectives on what healthcare needs to be? What are the social aspects of health care that make us look at the most prevalent and cost-effective treatments [without] looking at the social roots and causes of disease? How can we improve that? When I looked at programs, I didn’t only look at the opportunity to have amazing professors but was looking for a global health perspective…When I found this program, I felt like it had been made for me.

BAM: A lot of the Global Health Delivery students say that. What has been something you’ve enjoyed about the program so far?

SOV: Something I love about this program is the ability to cross-register into Harvard and MIT classes because I want to give my curriculum different perspectives, not just from a biosocial approach but also from the perspective of technology. For instance, I cross-registered into MIT classes on healthcare ventures and bioethics in artificial intelligence last semester, and this semester I am taking a leadership course at the Kennedy School and a negotiation class at the Education school. The possibility of moving around the different schools has been very good.

BAM: Now that you’re doing your research, I’d be curious to know: What surprised you the most in your first year?

SOV: That Harvard opens your world to knowledge. It’s not only that you have access to your professors and your classes, but that you can go more abroad and look at other perspectives and enroll in other classes. You’re reading books and doing assignments, but you’re also learning from your classmates and their perspectives on similar problems you’re having in your country. My brain is like a sponge, so I try to understand different contexts.

BAM: I’m glad to hear you’ve taken advantage of the cross-registrations between the different Harvard campuses! Was there a core class in the MMSc-GHD program you liked the most?

SOV: I think that all the classes are all amazing. I think the professors work hard to give you a different perspective. From Mary Kay [Smith Fawzi] in Quantitative Methods, Hannah [Gilbert] with the Qualitative Methods, to Byron [Good] and the faculty with Ethnography…I think the class that I really enjoyed was the GenEd1093 [Who Lives, Who Dies, Who Cares?] with Paul Farmer, Salman Keshavjee, Anne Becker, and Arthur Kleinman. I really loved that class because it really contextualized the issues and social suffering and what we need to do in the world. And Joia [Mukherjee]’s class is a different approach from the classes because she started with case studies and had all of the students comment on them and bring new ideas on how to fix the problem and create new models. A really excellent approach to teaching.

BAM: I want to talk about your project. You didn’t go back to Colombia the way many of your classmates went back to their home countries. I’m curious about why you chose to do that, and if it presented any challenges you’d like to discuss.

SOV: It’s funny because my project is related to the impact of telemedicine, and when I was deciding if I should go back to Colombia or stay [in Boston], it was a hard choice. But I decided to stay because I wanted to enjoy the summer in Boston and because I wanted to take fall courses in person…I mean, the project that I’m working on is with the company where I work. I was a COVID-19 leader that worked with my team to create public health policies, so I felt safe [doing this work]. I know the people who will do the interviews. We already have the information, the records, and the data that I’m asking for and trying to collect. For me, it was an easy path not to return to Colombia and stay in Boston to do my elective classes.

BAM: So now that you are pursuing the project, how do you feel the program prepared you for your research?

SOV: I feel like the program helped me by providing that perspective on different approaches to health care solutions. For example, in Colombia, we have had national insurance since 1993. Colombia is divided up into different states, and in the city, we think that everyone has access to care, but if you travel to the more rural places, you wouldn’t think that anyone has insurance. So, for me, when people mention telemedicine, they think that it will help those [rural] populations have more resources since they live so far away. But for me, when I was a leader, I thought that you could give patients access by phone or using the internet, or using an app. What I didn’t think about were all the supply chains that are needed to get to that patient. For instance, a physician gives you medical attention, and they suspect that you have COVID-19 and need a test. Okay, but where are you going to find a provider [in your area] who’s going to give you a test? If you don’t have a test, you have to quarantine for 15 days. For those populations, this is a direct economic impact. So, what are health care policies going to respond to that? How can health care alleviate that social suffering? These are perspectives I was given through the program.

BAM: I’m glad to hear that you’ve gotten this perspective, and I’m curious to see how it impacts your research. As of now, what are your plans for collecting this data?

SOV: As I’ve said, we really don’t know what the impact of telemedicine during the pandemic was. And what I mean about impact is that we don’t know what population is seeking medical attention this way. Is it the same pre-COVID population in the main cities, or has it changed? How has the distribution of care changed? For the quantitative part of my project, I want to measure what the impact is and compare who is seeking telemedicine and who seeking the physical emergency room, especially if those two people have the same symptoms and are of a similar age. The qualitative part will include interviews with managers, doctors, nurses, and primary responders about the change and challenges they had with telemedicine during the lockdowns. Because they were the ones who were dealing with patients directly in person and then had to switch completely. I think this brings them challenges, and I want to explore them.

BAM: Thank you for sharing your work with us. I’m excited to see your presentation in May. What advice do you have for those interested in this program?

SOV: I think that my advice is to believe in yourself. Sometimes Harvard makes you feel the Imposter Syndrome, and you feel like your letter of acceptance happened because a gust of wind blew it out of the rejection pile into the acceptance pile. Deal with your fears and try to understand that being here represents a chance that fewer than .5% of the population get to have. Take advantage of everything a university can give you. You have a curriculum that is designed to make you a global leader but try to explore what you want to do with your life. Do you want to introduce technology to your country? Try to take classes that help you with that. Do you want to become a leader? Choose those electives and find professors that you want to learn from. Try to take advantage of the infinity of possibilities that Harvard offers its students. Always remember: What is your purpose?

Project Title: Investigating the Challenges and Opportunities of Health Information System Integration to Improve Care Delivery in Pregnancy and The Postpartum Period in Haiti: A Convergent Mixed-Methods Design
Project Location: Haiti

By Bailey Merlin

Before joining the MMSc-GHD program, Benito D. Isaac worked as a Project Manager for Zanmi Lasante, the sister organization of Partners In Health in Haiti. He managed a portfolio of 5 grants totaling 4.5 million USD. Benito attended College at the Centre de Techniques de Planification et d’Economie Appliquée (CTPEA), Haiti, from 2008 to 2012, where he majored in Applied Economics with a specialization in statistics. We are grateful to have his perspective and wisdom in GHD classrooms.

During their time in the program, students must complete a large research project that requires them to conduct research in the field. For Benito, he’s returned home to Haiti to investigate health information systems (HIS) and how they might be improved to achieve equitable access to health care. For him, Maternal Neonatal and Child Health (MNCH) is among the health services where good data management is critical in enabling good care delivery for vulnerable groups such as women and neonates. According to Benito, “HIS enable informed decision-making at various levels and process-optimization in care provision. Yet, in resource-limited settings like Haiti, HIS are often highly fragmented and complex, with uneven development across geographical and technical areas. The result is low-quality data, often unexploitable. This is the case in Haiti, where an overcrowded donor landscape’s unique and often competing priorities have shaped the health system’s contours.  Stand-alone or vertical programs drive the health information systems that have emerged. The result is a chaotic and inefficient system that encourages unnecessary duplication of services and infrastructure, ultimately undermining patient care. The challenges surrounding HIS improvement in such contexts aren’t purely technical. Still, they include multiple layers related to power relations—for instance, donors’ priorities versus local care providers—and issues arising from resource limitations and other socio-technical complexities. This study seeks to understand these issues in the specific context of providing care to pregnant women in Haiti and the opportunity to achieve HIS integration by factoring in the constraints imposed by the local context and the overall national ecosystem.”

Because Benito had already completed GHDI (a required three-week intensive program hosted by the School of Public Health), he started research earlier in the summer. He took the time to answer our questions about his project. We look forward to welcoming him back to Boston in January.

What has surprised you the most about your project so far? 

I’m mesmerized by the richness of the experiential insights I gain from the conversations I have so far with people working at the very interface of Health Information Systems to provide care and those implementing or managing them. The study raises issues with practical implications for the work of doctors and nurses and those on the information management side of healthcare. The more I progress with the research, the more I learn how care providers (doctors and nurses) are concerned about fatal medical errors resulting from a lack of complete information about the patients they see and other similar issues. 

A nurse in a rural health center recently explained to me how they tragically lost a pregnant woman who experienced a fatal cardiac arrest while giving birth just because they did not know this woman also had separate paper records in the NCD clinics of the same health center where she was being seen concurrently. Have they had known about her status as a cardiac patient on time, they would have made the appropriate referral to a tertiary hospital where she could have benefited from multidisciplinary team support to safely deliver the baby.

What challenges have you faced while in the field? 

[In Haiti], you do not just send an email and people answer in less than 48 hours as in the US, where access to internet and electricity is far from being an issue. People might be busy solving real problems and doing their daily job…You sometimes need to show up without invitation (if needed) and ask (if possible) for a minute to discuss [the project]. My knowledge of the local context has been decisive when understanding the unwritten rules around finding the right person to talk to about the topics you want to discuss.

What hopes do you have for your research project? 

Very shortly, I hope to publish a paper in a scientific Journal out of this study. I also hope this study will shed light on the issues and the opportunities to improve HIS in Haiti while triggering concrete actions from the stakeholders to improve those systems in a way that considers the local ecosystem.

How has your time with the MMSc-GHD prepared you for your research? 

I had the opportunity to learn from experts at the very frontier of their field at Harvard Medical School. The skills I gained in study design and the readings I had during my degree have been incredibly helpful in the design and conduct of this study.

What advice would you give prospective students? 

Do not settle for the strict minimum while being at HMS. You are in a place where people are making an honest effort to be the best version of themselves. Be one of them. This program has a unique feature where you can modularize the content of the skillset you gain upon graduating. Take advantage of this, too. Think about your professional needs for the future and choose the electives accordingly. Harvard and MIT have combined their resources to offer you a large platform of cross-registration courses where you can take the courses you need as long as you meet the pre-requisite. But whatever your electives, make sure you speak and write good English. The general public will be unforgiving.

Beware! Even the introductory level courses you see at Harvard and MIT will deliver material content of a high level that will require earnest efforts from you, no matter what your background is. Simply avoid courses explicitly labeled “Advanced,” even if you took similar courses in a different academic context.

The good news is: If you show up to class on time every day, submit your assignments on time, do the required readings before class, and make an honest effort, you will do well. Harvard is more than a place where you learn academic skills: take the time to meet people with the same interest you have. The Innovation Labs is a great resource to try. I’m finally inviting you to take care of your mental health and enjoy your time in the United States.

Project Title: “Right to Health, Access to Healthcare, and Medical Neutrality in the Time of COVID-19 and a Military Coup: The Public Health and Humanitarian Crisis in Myanmar.”
Project Location: Myanmar

By Bailey Merlin

“I was born in Yangon (or, Rangoon) the year “Burma” was renamed “Myanmar.” Though I was born in Rangoon, I wouldn’t taste a Crab Rangoon until I got to the United States years later.”

After growing up in Myanmar, the Maldives, and India, Ye Mon went on to study medicine from Tbilisi State Medical University in Georgia, where she graduated in 2014. She began volunteering at the monastic hospital in Myanmar, one of the first charitable health organizations established by Myanmar citizens providing free healthcare to all. Having witnessed the co-dependency between poverty and preventable premature deaths in a fragile health system, she realized there was much more to fight than sickness itself.

In the pursuit of finding alternatives to address the health challenges, she joined Clinton Health Access Initiative to support National Malaria Control Program, moving towards malaria elimination efforts under Global Fund New Funding Model and Regional Artemisinin Resistant Initiative. In 2017, her work shifted to infectious diseases coordinating with the Ministry of Health and Sports to establish Myanmar’s first National Hepatitis Control Program. During her tenure, she supported innovative health technology solutions to improve the quality of services, capacity-building, mentoring health care workers, and expanding access to care in marginalized populations. In 2020, she was awarded the Fulbright scholarship and accepted into the MMSc-GHD program. In 2021, after the military coup in Myanmar, she led a research team at the Burmese American Community Institute to conduct humanitarian needs assessment among Internally Displaced People in Eastern Myanmar.

I reached out to Ye Mon to learn more about her research and experience as a Fulbright Scholar.

Why did you apply to the MMSc-GHD program?

I learned of the MMSc-GHD program through my mentor, an alumnus, and the first Myanmar student in the MMSc-GHD program. While working with him, I heard amazing stories of the course, the department, and the people. So, in the end, I was biased.

After learning more about the program, I couldn’t help but be compelled to apply for several reasons. The master’s program allowed the students to design a research project based on their interests which was a highly motivating factor. So, you will get to be the boss of your project and a paper to your name (if one desires) at the end of the degree program, having learned from amazing mentors (of your choice). In addition, the program is highly flexible, providing opportunities for the students to take electives across all other Harvard schools. At a personal level, the cohort size, the family-oriented and close-knit environment where every student is taken care of based on individual’s needs and professional goals, is one of the perks. In retrospect, applying to MMSc-GHD was like finding your professional tribe in the global health community where social justice and equity are highly valued.

How did you find out about the Fulbright scholarship for international scholars?

The Fulbright scholarship program is a well-known scholarship program back home in Myanmar, where prospective scholars have limited opportunities to study abroad. Every year, the U.S. embassy would organize information sessions and share information on the application process. I attended one of these sessions. Among my colleagues and peers, we kept ourselves updated on any scholarship opportunities in the U.S. and elsewhere through online forums and scholarship groups on social media.

What would you say you’ve enjoyed most about being a Fulbright scholar?

I have enjoyed the people the most in the Fulbright program. A wealth of experiences that the people bring from various backgrounds, countries, and cultures and learning from each other is truly an amazing experience. In my opinion, the program brings the world closer, and being able to tap into a wide network of expertise in all corners of the world has been extremely valuable. The Fulbright program is also a platform that you could leverage to share passionate causes and harness support from an influential circle of people.

It truly is a privilege to be among highly accomplished individuals. One day, while looking back, it is highly likely that the next Noble Peace Prize Winner or a president from a certain country was one the Fulbright alumni you used to hang out with.

What advice would you give to those hoping to become Fulbright scholars themselves?

I would advise prospective students to start applying early, talk to Fulbright alumni to be well prepared, and be as candid as possible in expressing your genuine self without reservation through essays and interviews. What I am suggesting is to give it utterly raw and to keep it memorably real! It is a very competitive scholarship program, and it’s easy to get frustrated and lose hope. I applied for three consecutive years, and only after my third attempt and a series of frustration did I finally get the award. So, please do not lose hope and keep applying until it’s yours because it will all be worth it at the end of the day.

P.S: Here is the link o the student directory where you can find a list of Fulbright alumni based on countries, year, and area of studies. https://foreign.fulbrightonline.org/alumni/grantee-directory. Reach out and connect! I found this extremely helpful and wish I had known of this earlier.

How has Fulbright benefited your education in the Master of Medical Sciences in Global Health Delivery program?

People say dreams are expensive, and so are mine. Without the support of the Fulbright Scholarship program, the dream of having an education in the MMSc-GHD program would remain to be a dream. It helped me receive a world-class education, learning from the most accomplished mentors and peers for which I’m immensely grateful.

The Fulbright program has early deadlines! We encourage you to learn more about individual country’s deadlines and requirements on the Fulbright website: https://foreign.fulbrightonline.org/apply

Project Topic: Exploring facilitators and barriers to implementing COVID-19 among citizens and refugees in Rwanda
Project Location: Kigali Rwanda

By Bailey Merlin

When he isn’t in the MMSc-GHD program, Theogene Ngirinshuti is the student services coordinator and lecturer at the University of Global Health Equity (UGHE), a Partners In Health initiative that trains global health leaders in Rwanda. He has taught ethics, political and legal philosophy at Arrupe Jesuit University in Zimbabwe. He has worked with vulnerable communities through the Jesuit Refugees Services. He holds a BA in philosophy and humanities and an MS in philosophy and public policy.

He credits UGHE as the birthplace of his interest in global health. He first joined the university as their first-ever Student Services Coordinator, where he worked to create an environment conducive to personal, professional, and academic success for students. During his time there, he worked with students, faculty, and administrators. Here, he was able to form his questions about health inequity, health education innovations, and understanding the roles that social sciences play in understanding and solving health problems. Theogene would later go on to teach in the UGHE Department of Humanities and Social Sciences before resigning his position to focus on the MMSc-GHD program and focus on his ambitions of becoming a leader in global health delivery.

Theogene’s thesis project will be a qualitative study of COVID-19 management and vaccine equity among citizens and refugees in Rwanda. He will conduct his study in Kigali, the capital of Rwanda, and in two camps of Congolese refugees to understand how the Rwandan government and the UNHCR/Rwanda manage COVID-19 vaccine equity among citizens and refugees. He and his team will explore facilitators and barriers to implementing COVID-19 containment measures among citizens and refugees in Rwanda, analyze refugees’ and citizens’ understanding and experience of the COVID-19 vaccine process and investigate the role of equity in COVID-19 vaccine distribution. He hopes his study will play a role in future pandemic preparedness, inform policymakers, and advocate for the most vulnerable Rwandan and refugee communities.

I caught up with Theogene to learn more about his project and the impact that COVID-19 has had on it and everything else.

What has surprised you the most about your project so far?

The high rates of vaccination in Kigali were very surprising. I never thought that I would conduct my research when 90% of all the people in Kigali, the capital city of Rwanda, would have been vaccinated at this time of 2021. This was unexpected. As I watched the Western economic powers scramble for COVID-19 vaccines, emptying the vaccine markets and hoarding nearly every dose, I was praying that we at least have a few in Rwanda and the developing world. But, as I speak, every person in Kigali and older than 18 is eligible for a COVID-19 vaccine. Nearly everyone I interviewed in Kigali is vaccinated. This was unanticipated.

How has COVID-19 impacted your study?

I expected to start data collection in August. However, it was delayed. The general practice to obtain approval for the Rwanda study consists of presenting the research proposal to the Rwandan National Ethics Committee (RNEC) in person. However, the practice changed, it transitioned online, and there was much research awaiting approvals. So, I had to wait longer for my research to be locally approved, and despite that, I have started collecting data in Kigali; I am still waiting for the Rwandan Ministry of Emergency Management, in charge of refugee affairs, to permit me to access the camps.  

What challenges have you faced while in the field?

COVID-19 has had long-lasting consequences on families and Rwandan society. There is hunger, pain, and hopelessness in some people. Parents have no jobs, no money, and no one is employing them; yet they have children looking up to them. It pains me to ask questions, listen to the challenges of my research participants and leave them without doing anything to help alleviate this suffering. How do these parents behave in the face of a hungry and crying child, knowing that there isn’t much hope on the horizon?

What hopes do you have for your research project?

This research will help in uncovering the real challenges that people are facing during this time of COVID-19. I hope that the knowledge gained will help policymakers develop immediate, short-term, and long-term solutions for COVID-19 related challenges and other challenges that COVID-19 is making manifest. We hope that this research will advocate for the most vulnerable and come up with useful recommendations for future pandemic preparedness.  

How has your time with the MMSc-GHD prepared you for your research?

The program has equipped me with knowledge and skills to understand where people fall sick and heal from. The program has introduced me to the bio-social approach to understanding diseases. While pathogens cause diseases, there are also socioeconomic and political causes of diseases. Thus, as I carry out my research, I use these tools to understand the context. I am always reminded of the social theories and their impacts on understanding the complexity of the problems. More importantly, I was equipped with research skills. For instance, the courses in ethnography and qualitative methods have given me the ability to have meaningful conversations with people and helped me develop a critical and observing eye. Moreover, despite conducting a qualitative study, the quantitative and mixed methods have equipped me to understand the complexity of conducting research.  

What advice would you give prospective students?

This is an excellent program. It offers practical and theoretical multidisciplinary knowledge that grounds students in global health and prepares them to be competitive and effective in other fields. This is not another typical academic program. It is a family where you are valued and appreciated. It is a place where you will find genuine friends interested in your growth. Its international nature provides an amazing opportunity for network and collaboration. The program has the resources you need to succeed, and it will connect you to other great schools within Harvard and beyond. It is an open the door to the world.

Project Topic: Improving supply chains for maternal and child health initiatives
Project Location: Neno, Malawi

Before joining the GHD program, Kapira worked with Partners In Health in Malawi as a Maternal Health Coordinator. Working in a rural area in Malawi as a clinician responsible for maternal health in a broken health system society, helped reduce the suffering patients and clients face through the training and mentoring of staff on maternal and child health initiatives, supported health programs that improved Maternal and Child Health infrastructure, supply chain, systems, and clinical tools. His passion for these maternal and child health initiatives are what encouraged him to apply to the MMSc-GHD program. His thesis project will focus on assessing the barriers of contraceptive uptake among adolescent girls in a rural district in Malawi. We reached out to Kapira to find out more about his research experiences in a landscape that is vastly different than originally anticipated.

What has surprised you the most about your project?

As I started quantitative data collection, the figures were relatively low for the contraceptive uptake among adolescents compared to the number of pregnancies reported. Qualitatively, I had assumed that culture plays a significant role in adolescent pregnancies. However, surprisingly, no stakeholder has mentioned culture as the reason for either adolescent pregnancies or the low uptake of the contraceptive services by adolescents.

How has COVID-19 impacted your study?

So many things have changed with the coming of COVID-19. Primarily, people are not turning up for the services at the hospital, resulting in even lower uptake of contraceptive services by adolescents. There is a great fear of COVID-19 among the general population. Additionally, health personnel's attention shifted from concentrating on contraceptive services to COVID-19, including budget allocation. All available resources are diverted towards COVID-19 prevention and treatment.

What challenges have you faced while in the field?

I've been most surprised by the suffering of adolescents impacted by unplanned pregnancies who are left to raise a child as a single parent with no financial assistance from others. Before joining the GHD program, I assumed that there was someone to take care of such adolescents. Instead, these individuals have to stand on their own and do what they can to support themselves and their children.

What hopes do you have for your research?

The hope for this research work is to inform the policymakers on some of the challenges that adolescents face in accessing contraceptive services, reducing adolescent pregnancies. The research would help the whole government develop new policies that put adolescents at the forefront in issues that concern their health. The study will also inform and empower adolescents to take a leading role in decisions that pertain to their health, contraceptive health services in particular.

How has your time with the MMSc-GHD prepared you for your research?

Provision of lessons in statistics and epidemiology helped me in my quantitative skills. Qualitative, ethnography, and mixed methods courses offered by the department played a significant role in understanding the qualitative part. Besides these, the support from mentors and faculty members helped me a lot in this research work.

What advice would you give prospective students?

Focus on the task at hand and submit all assignments within the given time frame. The early identification of mentors will allow you to work with them closely and ultimately benefit your research.

Project Topic: Providing employment to formerly incarcerated opioid users.
Project Location: Boston, Massachusetts

Rob Mancuso is a second year MMSc-GHD currently conducting his thesis research in the Boston, Massachusetts area. With a background in finance and investment, Rob is a welcome addition to the MMSc-GHD program because of his unique perspective on global health. His thesis explores the impact the opioid crises in Massachusetts had had on those recently released from incarceration. The MMSc-GHD program reached out to Rob about his experience in the field and the impact COVID-19 had had on his research.

What hopes do you have for your research?

I hope that my research will educate people on treatments and tools that are available to reduce opioid addiction.  Additional governmental funding is also critical to support services needed to bolster individual confidence and self-worth, such as employment, and provide social services such as sober living housing, transportation to treatment centers and programs like Narcotics Anonymous to stave off relapse.

What challenges have you faced while in the field?

The extent and level of devastation seen in the faces of opioid users in the South Bay area of Boston has been most striking to me.  Fortunately, I have also witnessed a few drug users who have succeeded in restarting their lives in a positive direction.  It has also been inspiring to see the deep compassion embodied by a number of individuals to help people in their fight to remain sober.  These include both clinicians in treatment and rehabilitation programs as well as those in prisons such as the Suffolk County House of Correction who work to implement educational programs that provide knowledge and hope.

How has COVID-19 impacted your study?

Covid-19 has been a challenge for this population.  The Department of Corrections was shut down for over 6 weeks this past Spring.  Inmates were provided only 30 minutes free time outside of their cells.  Baloney sandwiches were the norm and food could only be eaten within the cell.  Calling family was also restricted.  Estimates of well over 500 prisoners in the total Massachusetts system contracted COVID, adding significantly more stress to the already challenged prison environment.  The impact on my research has thankfully been limited given the ability to communicate via zoom.  However, in-person interviews are always more effective in drawing out nuances.

How has your time with the MMSc-GHD prepared you for your research?

The MMSc-GHD program provided me with critical new knowledge, especially considering my previous business background.  Of course, I have been amazed by the talented and knowledgeable professors at Harvard and especially the time they allocate to ensure students understand the depth and breadth of the concepts.

What advice would you give prospective students?

Get the books early and start reading!