“It started with a couple of e-mails from a couple of residents,” remembered Mark Gentry, a clinical support librarian in the Cushing/Whitney Medical Library. Yale residents doing rotations at Makerere University in Uganda, a partner with the School of Medicine since 2006, needed library resources. Since Internet access in Kampala was unreliable at that time, Gentry started with portable solutions, like CDs with e-books on the diseases that fill the wards of Mulago Hospital—tuberculosis, malaria, and HIV/AIDS. He has made similar compilations of medical and language resources for Yale faculty and students traveling to other destinations.
But Gentry kept thinking of the Ugandan doctors who, day in and day out, lack access to a modern medical library. “I wanted to go beyond just seeing what we could do for our little group of people from Yale,” he said.
Gentry began a close collaboration with his librarian colleagues at Makerere University that has brought him to Kampala twice. Such relationships are becoming more common as Yale’s medical library serves an increasingly global clientele. For example, Special Projects Librarian Charles Greenberg works with librarians and medical researchers in the Republic of Armenia to help them bring their professions into the digital age. Yale librarians are also key partners in the Health InterNetwork Access to Research Initiative (HINARI), a program set up by the World Health Organization and major publishers that offers scientific resources to developing countries at little or no cost.
“I didn’t really have a good sense of what libraries were like in developing countries,” Gentry said, recalling his first trip to Uganda in 2008. He discovered a library mainly dependent on paper books—and aging ones at that. Gentry worked with what he found. For example, network speed in Uganda is slow. So he helped an information technician at the library to build a home page with direct links to HINARI, The New England Journal of Medicine, and BMJ (formerly British Medical Journal), both of which are free in developing countries. That home page saved doctors precious time in their searches.
Gentry has cajoled Yale faculty and students going to Uganda to pack items that Cushing/Whitney is discarding but would be welcome at Makerere. When Kenneth Miller, M.D., assistant professor of medicine, arranged to refurbish a retired mammography van and ship it to Uganda, Gentry filled it with used computers, journals, and books.
Gentry encouraged his Ugandan counterparts to step outside the library. “Let’s go into the hospital,” he suggested. Back in New Haven, Gentry finds less of his time is spent working with doctors in clinical settings. He’s more likely to be designing ways for library users to access information from their smartphones and from clinical sites outside of New Haven. But the principle is the same, he explained: “Get the information to where people are working.”
Attendance has been declining in library research classes, reflected Greenberg, because patrons can learn those skills online. But he is glad that he was teaching a class in the library in 2007, when Gevorg Yaghjyan, M.D., Ph.D., a visiting plastic surgeon from the Republic of Armenia, dropped in. When Yaghjyan urged Greenberg to journey to Armenia to provide similar instruction, the librarian thought, “Ooo, that’s a wonderful dream.” Yaghjyan persisted and found a Fulbright Scholars program (http://www.cies.org/specialists/) that would fund Greenberg’s trip to Yerevan State Medical University (YSMU), where the surgeon is vice rector.
Library science training has suffered in Armenia since the demise of the Soviet Union, explained Greenberg. “People stopped going to library school by the mid-1990s,” he said. Consequently, Armenian medical libraries deemphasize electronic resources. “The priority of the YSMU chief librarian was to finish the cataloging project of the print collection,” said Greenberg. Before making the trip, he surveyed librarians and selected researchers on their knowledge of biomedical research skills. In general, the researchers knew more about information resources than the librarians.
But Greenberg found an ally in Anna Shirinyan, the director of the Republican Scientific Medical Library, which tries to function as a national medical library. Since Greenberg finished basic classes with librarians and researchers in 2008, the pair has worked on grant proposals to bring him back again. They want to elevate the role of the librarian from a cataloger to a clinical and research educator who helps patrons access the information they need. Greenberg sees possibilities for his own students—he teaches graduate library science online at San José State University—to work with future medical librarians in Armenia. He would also like to make it possible for Armenian librarians to enroll in his course for credit. For example, how does a student in Yerevan earn an online masters in library science on an Armenian salary?
There are always logistical hurdles involved in working with less developed countries. Gentry found himself doing his own wiring to improve connectivity for Yale staff in Kampala. Greenberg lost a precious day of classes helping his students deal with e-mail difficulties. But the incentive for these collaborations is quite simply better health. For example, 13 percent of Armenian children under the age of 5 suffer from chronic malnutrition, according to UNICEF. The organization puts life expectancy in Uganda at just 52 years for women and 53 for men. Without better access to information, librarians say, it will be difficult to improve those numbers.
“Imagine that the physicians that were trying to do research at the Yale School of Medicine had no access to the published journal articles their colleagues were using,” explained Kimberly Parker, now program manager at HINARI and a former YSM librarian. “They had no idea about whether particular drugs had been banned recently or that someone had discovered a better drug to use in the situation … Without any of that information, it’s like you’re in a vacuum and you repeat work that other people have already done. You come up with ideas that may be 10 years out of date.” Parker worked on HINARI’s development while she was at Yale, and the project continues to depend on YSM librarians to manage its vast array of resources. Teaching librarians in developing countries how to use HINARI is one of the best ways to improve access to research, said Gentry and Greenberg.
International library exchanges are meant to build capacity, said Gentry, which means that he continues to keep in contact with his Ugandan colleagues. Often, he said, access to better research points up a need for treatments not available in the country. But he has found doctors are determined to learn about best practices and find ways to implement them. “People really work hard to get the resources their patients need,” he said.