According to Dr. Tittle, working in a resource-challenged hospital such as the one in Hinche is an irreplaceable experience. She and Dr. Verma discovered new levels of meaning in the term “workaround.” For example, “we have really limited lab capacity,” Dr. Tittle says. “One interesting thing I learned is how much your lab depends on access to reliable electricity. A number of our machines have been ruined because of electrical power surges. There are only certain people in the lab who know how to run certain tests.”
Dr. Tittle has learned that “you can’t practice medicine [in Haiti] without addressing the system.” Exposure to QI methods during training have been useful, she says, as she and Dr. Verma designed a medical education seminar for their Haitian colleagues by identifying the top 10 diagnoses in the nursing discharge registry. Still, she admits that the effort was hampered by nonspecific diagnoses—again a result of their inability to run diagnostic tests.
The learning has been reciprocal, notes Dr. Jacquelin Pierre Auguste, one of the Haitian internists in Hinche.
“We share a lot of knowledge,” he says, enthusiastically.
One example Dr. Pierre shared was being able to bring the clinical fellows into the case of a young mother who had developed postpartum cardiomyopathy. For unknown reasons, the condition is 10-20 times as common in Haiti as in the U.S., according to Dr. Le, who is co-director of the UCSF Global Health-Hospital Medicine Fellowship program. “Our fellows are also learning much more about the management of late-stage disease in tuberculosis and HIV,” he adds.
Several hospitalists have witnessed misappropriation of resources in global health projects, which can occur during emergency situations, such as in post-earthquake Haiti. For benefits to be sustainable, it’s best not to “charge in,” but to carefully assess the needs of the host setting. Although needs assessment should be handled by the sponsoring organization, hospitalists can contribute to this effort so that well-intentioned relief efforts do not cause unintended consequences, Dr. Hendel-Paterson says.
Dr. Pierre confers with Partners in Health hospitalists at St. Thérèse Hospital in Hinche, Haiti
Hospitalists Unite
In the global health survey conducted in 2012, Drs. Shoeb and Le found that 46% of respondents were interested in collaborating with other hospitalists in order to increase their impact on health equity. In response to these and other observations about a need for mentorship, SHM established a Global Health and Human Rights Section, chaired by Drs. Shoeb and Le. They will be hosting a special global health forum at HM14 later this month in Las Vegas (www.hospitalmedicine2014.org).
The section goals are to:
- Provide a forum for like-minded hospitalists to share experiences and knowledge;
- Enhance the skill sets of hospitalists to apply their expertise in resource-poor settings; and
- Strengthen the capacity of local health systems through long-term collaborations and training in quality improvement.
Dr. Le, who has been affiliated with Partners in Health since his residency at Harvard Medical School, has spent time in sub-Saharan Africa as well as Haiti. He has been instrumental in advancing the HM global health agenda at UCSF and helped to organize the first national retreat on global health in HM last year. The program held its second annual retreat in February 2014.
Besides UCSF, two other global health fellowships are designed specifically for hospitalists: the University of Chicago Global Hospital Medicine Fellowship is headed by Evan Lyon, MD, an assistant professor of medicine in the section of hospital medicine in the UC Department of Medicine; the University of Florida College of Medicine’s Global Health-Hospitalist Fellowship program in Gainesville is headed by Vincent DeGennaro, Jr., MD, MPH, assistant professor in the division of hospital medicine.