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Haiti is an island nation with a population of nearly 10 million. With less than one physician per 10,000 population prior to the 2010 earthquake, Haiti had a fragile health infrastructure, but the blow of the earthquake and the destruction of many clinical health structures and teaching facilities has rendered Haiti even more vulnerable.
With a life expectancy of 61 and an infant mortality rate of 60, Haiti’s health outcomes are the poorest in the Western Hemisphere. Despite this, the Haitian people and health workers are resilient and are determined to improve the care delivered to children. The Global Pediatrics Program is working with Partners In Health (Zanmi Lasante) in Haiti
Our Global Pediatric Fellowship Program places 2 pediatric fellows in Haiti at PIH-affiliated sites for 2 years. Since August 2011, Global Pediatric Fellows, Sara Gonzalez and Chris Carpenter, have been working at St. Marc, collaborating with local doctors and nurses to help improve care in the pediatric ward.
Their focus has included training and quality improvement in neonatal care, in nursing care, and in care for malnourished children. When the fellows are not addressing the most basic needs of the pediatric patients, they engage in clinical education, curriculum development, didactic teaching and mentorship for medical staff and family practice residents.
CHB faculty and staff have been collaborating with PIH and the Department of Global Health at HMS on initiatives to improve neonatal care in Haiti. These initiatives include: faculty and nursing observerships, on-site clinical training with CHB nurses and physicians, development of clinical guidelines, and training of Haitian staff in Helping Babies Breathe. The current global pediatrics fellows' work has included a nursing mentorship project, connecting Haitian care givers with BCH neonatal nurses to train them as master trainers in neonatal care for Haiti.
In collaboration with Haitian surgeons, the global surgery team at Boston Children's Hospital has developed strategies for advancing the delivery of global perioperative care as well as publishing and developing the understanding of the role for surgery in global public health.
Global Surgery Fellows provide a permanent clinical presence at PIH sites in Cange and Mirebalais. Research in Haiti will continue in the areas of surgical clinical outcomes, quality improvement, surgical training and capacity building, and cost-effectiveness/cost-benefit analyses for surgical and anesthesia services. Fellows will further contribute to surgical education through future training initiatives at Mirebalais and through the continued mentorship of sub-interns at Cange.
Boston Children's hosts both the clinical component and the research component of the Paul Farmer Global Surgery Fellowship, in collaboration with Partners In Health and the Program in Global Surgery and Social Change at Harvard Medical School.
Through the Paul Farmer Global Surgery Fellowship, dedicated surgeons obtain the academic, clinical, and administrative skills necessary for leading change and improving surgical care delivery, surgical systems development, and humanitarian aid in resource-poor settings.
With affiliate status in the Department of Global Health and Social Medicine, Fellows will continue to play a vital role in fulfilling educational and research objectives in both the short and long term. In 2012/13, the current team of 1 clinical fellow, 3 research fellows, and 4 students will expand to 2 clinical fellows, 8 research fellows, and 5 medical students.
Haiti and Rwanda each have approximately 5 psychiatrists serving 10 million people. Giuseppe Raviola, MD, Director of the Psychiatry Quality Program in the Department of Psychiatry at Children’s Hospital Boston and Director of Mental Health at Partners In Health, has led, with Haitian colleagues, a community-based approach to the stepped articulation of an evidence-based system of mental health care to meet long-term mental health needs in Haiti following the 2010 earthquake.
Dr. Raviola has worked closely with a Haitian staff of psychologists, social workers, and community health workers at Zanmi Lasante, collaborating closely with the Haitian Ministry of Health and other local NGOs, and leading curriculum development and supervision of training of clinicians.
He also manages a number of collaborations that have supported the development of a locally valid and reliable depression screening tool for use by community health workers, and the adaptation of an evidence-based psychosocial treatment to the Haitian context. He has also led the process of organizing a new Hospital Mental Health Service at Mirebalais Hospital, including a mobile mental health team that will be based out of the hospital.
In 2010, Dr. Raviola developed a new fellowship in global mental health delivery, the Dr. Mario Pagenel Fellowship, shared by PIH and Harvard Medical School. The fellowship honors the life and work of Dr. Mario Pagenel, director of training and medical education at ZL, who had a special interest in mental health and health equity, and whose life was taken in the earthquake.
This year’s fellows, early career US psychiatrists with interests in academic careers in global mental health delivery, are currently stationed in Haiti and Rwanda. An additional psychiatrist position will be posted in Rwanda through the new MOH Human Resources for Health.
Recent Updates from Haiti can be found here.
Dr. Paul Farmer recently spoke at a lecture on the work being done in Haiti. This lecture can be viewed here
The future of pediatrics will be forged by thinking differently, breaking paradigms and joining together in a shared vision of tackling the toughest challenges before us.”