The Future of Global Health Capacity Building at Yale
April 14, 2021ID6438
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- 00:00I'd like to welcome everyone who is
- 00:02joining us today for our panel session.
- 00:05So this is part of our 10th
- 00:07Annual Global Health Day in the
- 00:09Department of Internal Medicine
- 00:11and our theme this year is global
- 00:14health capacity building at Yale,
- 00:15past, present and future.
- 00:17So this morning during our
- 00:19medicine grand rounds,
- 00:20we heard from Doctor Oscar Rastagar
- 00:22who gave us an overview of where
- 00:24capacity building in the L Department
- 00:26of Medicine has come over the
- 00:29past several decades and today.
- 00:31We're very excited to have our panel
- 00:33discussion with your colleagues who
- 00:34are truly at the forefront of different
- 00:37aspects of global health capacity.
- 00:38Building here at Yale.
- 00:40So our moderator for today is
- 00:42going to be on Doctor Soto Meyer,
- 00:44who is the director of the
- 00:46Institute for Global Health.
- 00:47He's the associate Dean for Global
- 00:49Health Research and Professor of
- 00:51Medicine in the School of Medicine.
- 00:53He's also the Susan Dwight Bliss professor
- 00:55of Epidemiology of Microbial Diseases
- 00:56at the Yale School of Public Health.
- 01:01We will have four panelists as I
- 01:03mentioned today and they will be
- 01:05going hopefully in this order,
- 01:07so Christina Talbert Slagle,
- 01:08assistant professor of Medicine in general,
- 01:10internal medicine and core faculty of
- 01:12the equity Research and Innovation
- 01:14Center at the Yale School of Medicine,
- 01:16as well as the associate director of
- 01:18the Yale Institute for Global Health,
- 01:20Luke Davis, who is associate professor
- 01:22of Epidemiology of microbial
- 01:24diseases at Field School,
- 01:25public Health and also associate
- 01:26professor of medicine and pulmonary
- 01:28critical care and Sleep Medicine
- 01:30at the Yale School of Medicine.
- 01:333rd we will have Evelyn Shape,
- 01:35Assistant professor of medicine and
- 01:36Rheumatology and Chief of Rheumatology
- 01:38at the VA Connecticut Healthcare System
- 01:40and Associate Assistant professor
- 01:42of Epidemiology of chronic diseases
- 01:43at the Yale School of Public Health
- 01:45and last but definitely not least,
- 01:47will have Christine and Gloria,
- 01:49who's assistant professor of emergency
- 01:50medicine at the Yale School of Medicine.
- 01:53So with that,
- 01:54I'm going to turn it over to side
- 01:56to give a little bit more of an
- 01:59introduction for our first panelist today.
- 02:01So for Christina.
- 02:05Hi, it's my pleasure to moderate
- 02:08this session and sort of
- 02:10the Department has been at the forefront
- 02:13of capacity building an and coming up
- 02:16with new equitable models. City building.
- 02:20In in global health so so my it's my
- 02:23pleasure to introduce the first panel
- 02:26panelist Doctor Christina Talbert
- 02:28Slagle she's the associate director of
- 02:31Yale Institute for Global Health and
- 02:34an assistant Professor of Medicine at
- 02:36the Yale School of Medicine in general
- 02:40internal she's a global health scholar
- 02:42and educator and she is focused for
- 02:45several years on addressing health and
- 02:48educational disparities around the world.
- 02:50Through her focus on really high quality.
- 02:53Interactive teaching and locally
- 02:55appropriate and responsive scholarships
- 02:57and field programs, which is a
- 03:00particular strength of her with her.
- 03:03Her PhD was in genetics and biology and
- 03:07postdoctoral training was in complex
- 03:09systems and global health Management.
- 03:12She approaches her work,
- 03:14teaching and mentorship through
- 03:16and a very really,
- 03:18truly interdisciplinary perspective.
- 03:20In addition to her role at VGH.
- 03:23They said she had several
- 03:27other appointments and.
- 03:30And she's the she's the faculty director for,
- 03:33among other things of for health
- 03:36management and preclinical education,
- 03:38workforce capacity building
- 03:39programs in Liberia,
- 03:40and she's been working closely
- 03:43with colleagues at TL and in
- 03:46Liberia on that kind of work.
- 03:48And a little bird tells me that that
- 03:52that relationship is likely to expand
- 03:55exponentially in the next few weeks.
- 03:58And I'm hoping Christina you're
- 04:01comfortable with me saying that,
- 04:04and officially this forum,
- 04:06but it's my pleasure to welcome doctors,
- 04:09Talbert Slagle.
- 04:14Thank you so much.
- 04:15Sad, that was a wonderful introduction.
- 04:17I appreciate it and thank you
- 04:19Tracy and the Office of Global
- 04:21Health for having me today.
- 04:23As part of this esteemed panel.
- 04:25I'm grateful to be here,
- 04:27so I'll just share my screen.
- 04:29I have just a few slides to to
- 04:31give some information about the
- 04:33work that I do and kind of touch
- 04:36on the future of global health
- 04:38capacity building at Yale, so.
- 04:41Can you see this?
- 04:43Great, OK, so just quickly as Asad mentioned,
- 04:46I work with colleagues in the West
- 04:49African country of Liberia so just
- 04:51to Orient everyone that Liberia is
- 04:53in the West African sub region and
- 04:56it's shown here in dark red and
- 04:58then this is a close up so it's
- 05:01a small country geographically.
- 05:03It's about the size of this state of
- 05:05Tennessee and there about four 4.5
- 05:08million people who live in Liberia.
- 05:11I I wanted to,
- 05:12even though we're talking about the future,
- 05:15I think it's important to root
- 05:17our work in the past,
- 05:19at least in understanding some historical
- 05:21context of partnerships and and why
- 05:24things are the way that they are.
- 05:26So I wanted to show this.
- 05:28This is a mural on the base of
- 05:30the statue in the capital city of
- 05:33Monrovia showing an interesting
- 05:34interaction whenever people from
- 05:36the United States were brought to
- 05:38the country of Liberia as part of
- 05:41the American Colonization Societies.
- 05:42Efforts in the mid 1800s an on
- 05:44the left you have people arriving
- 05:46and on the right you have people
- 05:48who are already there and this is
- 05:50actually why Liberia is called
- 05:52this because there was this push
- 05:54from the United States to.
- 05:56Repatriate people from the United
- 05:58States back to Africa, supposedly.
- 05:59But in fact,
- 06:00many of the people who came to what is
- 06:03now known as Liberia were from all over.
- 06:06Including born in the United States.
- 06:09This is the flag of Liberia,
- 06:11and it just obviously reflects the flag
- 06:13of the United States and shows this close,
- 06:16but kind of interesting and complex
- 06:18relationship between the United
- 06:20States and the country of Liberia.
- 06:22And then here I just am showing
- 06:25a little close up.
- 06:26Liberia has 15 counties and the
- 06:28country the capital city of Monrovia
- 06:30is actually named after James Monroe.
- 06:32Marilyn County obviously is a
- 06:34familiar name in the United States,
- 06:36so there's this long interesting
- 06:38tie between the two countries.
- 06:40And then I'm fast forwarding now to
- 06:431989 whenever Civil war erupted in Liberia.
- 06:46This war erupted,
- 06:47basically as a result of an ongoing
- 06:50tension between the people who
- 06:52settled in Liberia in the mid 1800s
- 06:55as part of the American Colonization
- 06:58Society efforts and the people who
- 07:00were already there so that work a
- 07:03century and a half earlier gave rise
- 07:06to a civil war that was devastating,
- 07:09which is pretty well encapsulated,
- 07:11I think by this picture.
- 07:13There were lots of child soldiers.
- 07:15It was actually a period of
- 07:17civil wars over 14
- 07:19years. This is a famous picture
- 07:21because this is clearly a child with
- 07:23an automatic weapon and a little soft
- 07:25teddy bear backpack and it really was
- 07:28devastating to the country of Liberia.
- 07:30It destroyed so many systems and 2/3
- 07:32of health facilities in the country
- 07:34closed and many health providers
- 07:36left the country and went all over.
- 07:41But our partners there, Yale, actually.
- 07:43This is before my time,
- 07:45but GAIL was working with partners
- 07:47in Liberia after the Civil War,
- 07:49but our our colleagues there,
- 07:50many of whom I now have the opportunity
- 07:53to know we're working on rebuilding
- 07:55after the period of the Civil War.
- 07:58So what we're looking at here is
- 08:00just a graphic that shows under
- 08:025 mortality per 1000 live births,
- 08:04which is one of the ways that
- 08:06we can measure how a country is
- 08:09doing and its health condition
- 08:10in the population of its health.
- 08:13So you see Liberia here in blue,
- 08:15and then the bordering country of Guinea
- 08:18and the bordering country of Sierra
- 08:20Leone and red and green respectively.
- 08:22And this line is an average of the 15
- 08:25countries of the West African sub region.
- 08:27So we want these lines to be going
- 08:30down because this is showing a
- 08:32reduction in under 5 mortality.
- 08:34So you can see this starts in 1980.
- 08:37The lines go down.
- 08:38But then there's this increase in
- 08:40Liberia during the Civil War period,
- 08:42but the post Civil War post
- 08:44conflict rebuilding efforts.
- 08:45Were very successful an Liberia actually
- 08:48saw steep declines in this number,
- 08:50and it was a leader not only in
- 08:53its the neighboring countries,
- 08:55but actually in the region in
- 08:58reducing child mortality post war.
- 09:00And this is something that we kind
- 09:02of I I hadn't heard about as much
- 09:05because what we hear about more with
- 09:08Liberia is what happened in 2014,
- 09:11which was an outbreak of Ebola.
- 09:13And I'll talk about that momentarily.
- 09:15But I just wanted to take a minute
- 09:18to anchor us in this history of local
- 09:21leadership in the country of Liberia
- 09:23on building their health system,
- 09:25rebuilding post conflict,
- 09:27and all the deep experience that
- 09:29that the people in country have.
- 09:31On the capacity building work that
- 09:34I'm now privileged to be apart
- 09:36of so well before my time,
- 09:38people were doing great work in
- 09:40Liberia on rebuilding post conflict,
- 09:42but it was still a fragile country.
- 09:45The health system was very fragile
- 09:47and as many of us know in the
- 09:51year 2014 and into 2015,
- 09:52the Ebola virus emerged in this region
- 09:55of the world and it was devastating.
- 09:58So this is a picture maybe.
- 10:00Maybe people have seen pictures
- 10:02like this from this time period.
- 10:05West Africa and Liberia and Guinea and
- 10:07Sierra Leone in particular kind of hit
- 10:10the world map because everybody was
- 10:12paying attention to the Ebola crisis.
- 10:14But this really is a cross sectional
- 10:16indicator of a still fragile health system.
- 10:19In a post conflict nation that
- 10:22was working hard to rebuild.
- 10:24So the comp consequences of their
- 10:26Bola virus outbreak were devastating.
- 10:28What we're seeing here is a map.
- 10:31Again, here's Liberia,
- 10:33Sierra Leone is a bordering country Guinea.
- 10:35The Ebola virus actually emerged right
- 10:38at the Nexus of these three countries,
- 10:41and these colors show death the death toll.
- 10:44So as the the color gets darker,
- 10:47there are more and more deaths.
- 10:50So I'll just start in March of 2014
- 10:53and then the next graphic skips ahead.
- 10:56A year to March of 2015 and you can see
- 10:59that the virus had spread around this
- 11:03entire region and exacted a tremendous toll.
- 11:07Liberia lost more than 4000 people.
- 11:09I think it's 4800 and it was particularly
- 11:13devastating for the health workforce
- 11:15who did not have the resources that they
- 11:19needed to be able to protect themselves and
- 11:22their patients from this devastating virus.
- 11:25And so Liberia lost about.
- 11:278% of its health workforce from
- 11:31the Ebola crisis.
- 11:34So the Minister of Health at the time,
- 11:36Doctor Bernice Dahn, during the day,
- 11:38was working to combat the Ebola crisis
- 11:40and in the evenings was working with a
- 11:43large team to develop an investment plan
- 11:45for building a resilient health system
- 11:48in Liberia which they released you.
- 11:50It's a little blurry here,
- 11:51but they released it in April of 2015 and
- 11:54this is an amazing comprehensive plan
- 11:56that includes lots of different elements,
- 11:58one of which is health workforce capacity
- 12:01building so that I joined on to this.
- 12:04Standing on the shoulders of Giants,
- 12:06many people at Yale had, as I said,
- 12:08worked in Liberia for a long time.
- 12:10And, as Saad mentioned,
- 12:11I worked on health management
- 12:13and also physician training.
- 12:14And there's a whole team of us so
- 12:16I can talk more about this later.
- 12:19But the work that we're really doing now is.
- 12:22We're focusing on health management,
- 12:24capacity building, and education.
- 12:26There's a certificate program that
- 12:27our team is developed and handed
- 12:29over to the University of Liberia,
- 12:31and we're now working on really
- 12:34reforming undergraduate medical
- 12:35education at the only medical school
- 12:37in the country to strengthen the
- 12:38pipeline of physician training for that
- 12:40component of the health workforce.
- 12:42So I can talk more about that later,
- 12:45but that's kind of where we are
- 12:47and an on where we're headed.
- 12:49And it's just a real honor to be
- 12:52part of this work, so I'll pause.
- 12:54And then hand it to the next person.
- 12:59Great, thanks so much Christina pull up the
- 13:03slide for our next panelist. Here we go.
- 13:09So it's my pleasure to
- 13:11introduce Doctor Luke Davis,
- 13:12who's an associate professor of
- 13:14Epidemiology of microbial diseases
- 13:16at the Yale School of Public Health,
- 13:19as well as an associate professor
- 13:21of medicine and pulmonary
- 13:23critical care and Sleep Medicine.
- 13:25At the yield curve medicine.
- 13:27Doctor Davis.
- 13:29You know has worked substantially
- 13:31in many parts of the world,
- 13:34but specifically you know his work
- 13:37using translational research and
- 13:39implementation science to improve
- 13:40diagnostic evaluation in case finding for TB,
- 13:44which is obviously we know that is
- 13:47a leading cause of death in LMI CS.
- 13:51He teaches graduate course in
- 13:53implementation science and mentor
- 13:55students at the Yale School of Public Health.
- 13:59And has been in a leading role in
- 14:02international research training
- 14:03programs in LMS,
- 14:05so look over to you.
- 14:08Thank
- 14:09you so much so it's really a
- 14:10pleasure to be together today.
- 14:12I think so Tracy, for joining I
- 14:14always enjoy the Department of Mental
- 14:16Health Day is a chance to reconnect
- 14:18with colleagues and hear about all
- 14:20the great work that's going on.
- 14:22I'll just talk maybe for 5-5 minutes or
- 14:25to 7 minutes or so on our experiences
- 14:27working Uganda and I want to present
- 14:29that through the lens mostly of our work
- 14:32in implementation science and talk a
- 14:34little bit about how I've come to see
- 14:36through the collaborations with the
- 14:38other members of the Yellow Uganda network.
- 14:40Which involved research,
- 14:41training, clinical care?
- 14:42How these three legs of a stool,
- 14:45so to speak?
- 14:46It's really important to have all of them,
- 14:48and I think without any of them a lot can
- 14:52be lossed just a little bit by my story.
- 14:55I started out with my interest
- 14:57in Global Health after finishing
- 14:58my internal medicine residency.
- 15:00I spent some time working in
- 15:02a Mission Hospital in Kenya.
- 15:04It was a very formative time for me and
- 15:07I think for many people around the world as.
- 15:10They started to see the toll that the
- 15:13HIV epidemic was taking in Africa,
- 15:16particularly on young people,
- 15:18and also the combined Twins
- 15:20endemic of tuberculosis,
- 15:21which has a pulmonologist
- 15:23or abutting pulmonologist.
- 15:24At that time I was extremely interested in,
- 15:27and after spending some time,
- 15:29they're working in this Mission
- 15:32Hospital in a rural area where we
- 15:35took care of many patients from the
- 15:38Masai areas and the cool areas by.
- 15:41Just felt very called to try to work
- 15:43in this area of understanding how
- 15:46to diagnose pulmonary infections,
- 15:48which I think are the leading cause
- 15:50of death of people living with HIV,
- 15:53tuberculosis and other causes.
- 15:54And after undertaking some training
- 15:56in Epidemiology,
- 15:57I had the chance to start research
- 15:59project in Uganda which initially
- 16:01was focused on diagnostics and
- 16:03developing new diagnostics,
- 16:05and this was a really important
- 16:07time in Uganda with regard to
- 16:09tuberculosis research I think.
- 16:11Each of your research was
- 16:13already well established.
- 16:14It was a lot of malaria research
- 16:16that was well established,
- 16:17and a number of Yale faculty have
- 16:20been involved in those activities.
- 16:21But the growth of the tuberculosis
- 16:23research gave us an opportunity,
- 16:25I think,
- 16:26to understand all the needs
- 16:28that exist in that area.
- 16:29It's a very challenging infection in
- 16:31some ways more challenging than HIV.
- 16:33I know that Jerry Friedland likes
- 16:35to say that in the field of TV,
- 16:38people move at the pace of TV
- 16:40and we're trying to.
- 16:42Try to move more at the
- 16:44pace of replication of HIV.
- 16:45That is more quickly to get more
- 16:47solutions and after a number of
- 16:49years working in diagnosis in the
- 16:51process of trying to set up some
- 16:53field sites and in rural Uganda
- 16:55through a site that was some work
- 16:57that was in collaboration with
- 16:59Doctor Smeal Creek came to recognize
- 17:01that a lot of what we need to do to
- 17:04improve care of TV.
- 17:05We already know how to do it,
- 17:07it's just a gap between knowing and doing.
- 17:09And I came to that recognition
- 17:11that in setting up sites.
- 17:13In finding that a lot of people
- 17:15had the idea that there needed to
- 17:18be more education of providers at
- 17:20the front lines in rural areas.
- 17:22But when you went and talked to them,
- 17:25they knew the guidelines for tuberculosis.
- 17:27They knew how to manage it,
- 17:29what they did not have
- 17:31were reliable supplies,
- 17:32revival workflows,
- 17:32and in working in such systems
- 17:34being overwhelmed overtime,
- 17:36their motivation became sapped and
- 17:37so became interested in this field
- 17:39of implementation science and in
- 17:41collaboration with my colleague,
- 17:43Doctor Achilles Katamba.
- 17:44Who is a medical doctor and
- 17:46epidemiologist and investigators
- 17:47from another other US universities.
- 17:50We set up our research project
- 17:52called the Uganda TV Implementation
- 17:54Research Consortium where we try
- 17:56to work closely with and you got
- 17:59a national tuberculosis program
- 18:01an with local health facilities
- 18:03to try to identify what are
- 18:05national priorities for diagnosis,
- 18:07treatment and prevention of tuberculosis
- 18:09and how can we come in and contribute
- 18:13in an interdisciplinary way.
- 18:14Understanding the gaps and
- 18:16how to close those gaps,
- 18:17and this is the field of
- 18:19implementation science.
- 18:20Implementation Science is a term that
- 18:22I think is gaining a lot of interest.
- 18:24I think many of you are aware
- 18:26that at Yale we have in the school
- 18:28Public Health Center for methods
- 18:30and implementation prevention
- 18:31Sciences in the School of Medicine,
- 18:34and we have the Yell Center for
- 18:36implementation science and we also
- 18:38have a very active student group
- 18:40called Implementation Science
- 18:41Group at Yale that is helping kind
- 18:43of drive this research agenda.
- 18:44For Dan,
- 18:45it's really one of the exciting
- 18:47things about implementation.
- 18:49Science is that rather than staying
- 18:50in our silos as pulmonologists as
- 18:53epidemiologists as biostatisticians,
- 18:54we're opening up the gates and looking
- 18:57to other branches of science and saying,
- 19:00where can we borrow methods?
- 19:02Where can we build collaborations
- 19:04with individuals who can help address
- 19:06these challenges so the chance
- 19:08to work with engineers to come
- 19:10up with better diagnostic tests?
- 19:12The chance to work with our colleagues
- 19:15in social and behavioral Sciences and.
- 19:17The other social Sciences,
- 19:19including economics and sociology
- 19:21and anthropology,
- 19:22to try to understand behavior,
- 19:24try to understand costs.
- 19:26Try to understand truly how the social
- 19:29determinants of health really drive,
- 19:32the barriers that we see and
- 19:35seeking access to diagnostic.
- 19:36Excuse me.
- 19:37Diagnostic services for TV in Uganda
- 19:40for treatment and prevention.
- 19:43And shortly after getting some
- 19:45of those projects going,
- 19:46we also found the need to build
- 19:49the capacity of our teams that
- 19:51were carrying out that work.
- 19:53A lot of passionate young medical officers,
- 19:56laboratory technicians,
- 19:57even social science students,
- 19:58public health students were involved
- 20:00in our projects and we started
- 20:03to realize that maybe the older
- 20:05model of training everybody to be,
- 20:07say, a principal investigator,
- 20:09wouldn't be the most efficient approach.
- 20:11But then,
- 20:11if we cast a wide net and give
- 20:14people opportunity to pursue training
- 20:16so they became specialists able to
- 20:19contribute to multidisciplinary teams,
- 20:21that that might help us build better
- 20:24capacity for implementation science
- 20:25and so with funding from the Fogarty
- 20:28International Center starting in around 2010.
- 20:30We are a little bit after 2012.
- 20:33We started training scholars who are
- 20:35pulmonary complications of AIDS research
- 20:38training program and that's been a
- 20:40very successful program that's allowed
- 20:42us to partner with some of the other.
- 20:45Faculty here at Yale and many faculty
- 20:47in other areas who have interests
- 20:49in HIV and can link those two
- 20:51implementation science and working.
- 20:53Also at the institutional level to try
- 20:55to offer courses for not just students
- 20:57but also people who are in practice
- 21:00through an executive model where people
- 21:02can bring an idea that they need to
- 21:04carry out for their work at the national
- 21:07TV program or the Ministry of Health,
- 21:10or maybe for an employee with
- 21:12an implementing partner,
- 21:13they have a implementation
- 21:14problem that they want to address.
- 21:16And that by working through this curriculum
- 21:19they can hopefully come up with protocols,
- 21:22grant applications,
- 21:23and finish projects that can
- 21:25be collaboratively developed.
- 21:27The last piece I think in that stool.
- 21:30I've talked a little bit about research,
- 21:32implementation research.
- 21:33I've talked a little bit about training,
- 21:36implementation, research,
- 21:36training.
- 21:37The last piece is what I like to
- 21:40call implementation practice and
- 21:41in clinical medicine that could be
- 21:43thought of as quality improvement,
- 21:45evidence based medicine and public health.
- 21:47It could be thinking about how do we
- 21:50get the services and the practices that
- 21:53people need put into practice and not just.
- 21:57Journal somewhere,
- 21:58or even in the guideline.
- 21:59How do we go that next mile?
- 22:02And it's a great challenge.
- 22:03I think we can look to the model
- 22:05of HIV where there has been large
- 22:08scale funding from the US government
- 22:10from the Global Fund for AIDS,
- 22:12Tuberculosis,
- 22:12and Malaria in Uganda to build
- 22:14an incredible capacity and.
- 22:16And there is interest in using that
- 22:18HIV clinical capacity of a HIV
- 22:20clinics and ARTA clinics to add on
- 22:22care for non communicable diseases.
- 22:24That my colleague Jeremy Shorts
- 22:26is working on.
- 22:27We are very interested in non
- 22:29communicable primary diseases,
- 22:30tuberculosis of course,
- 22:31and I think that will be the next
- 22:33milestone in the future is how can
- 22:35we bring together clinical care and
- 22:38public health through implementation
- 22:39practice and that will require
- 22:41kind of more partnerships.
- 22:43And I think getting people interested
- 22:45in putting funding towards us.
- 22:46There's a lot of interest in research.
- 22:49There are a lot of young ugandan's who
- 22:51want to pursue careers in research,
- 22:53but we want them to do that without
- 22:56giving up on providing service.
- 22:58To end users to being in the clinics
- 23:00to providing their leadership
- 23:02capability to make sure that care can
- 23:04be delivered at that last mile without.
- 23:07I think I'll stop my comments and
- 23:09look forward to hearing the other
- 23:11presenters and hopefully having
- 23:13some conversation at the end.
- 23:16Yeah, so before I go to the
- 23:19next speaker next panelist,
- 23:21I will amplify what buffer
- 23:23ribbon put in the chat box.
- 23:25Please feel free to add your questions
- 23:28etc in the chat box in the in the QA
- 23:32box etc so that you know we can ask
- 23:35these questions from our panelists
- 23:38when we move to the next stage.
- 23:41The next panelist is Doctor Evelyn Hirsch.
- 23:45She's an assistant professor of medicine and,
- 23:49as in, is in, is a rheumatologist.
- 23:52She's also chief the Chief of Rheumatology
- 23:56at VA Connecticut healthcare system.
- 23:59She has her focus has been specifically
- 24:01an largely on integrating biomedical
- 24:04and behavioral research methods
- 24:06to improve outcomes of rheumatic
- 24:09and musculoskeletal disease.
- 24:11In countries in economic transition.
- 24:15And the major emphasis of this body
- 24:17of research has focused on mechanisms,
- 24:20Epidemiology and prevention of
- 24:22strategies of for osteoporosis among
- 24:25individuals with HIV in China,
- 24:26for example,
- 24:27as well as projects on other in
- 24:29other low resource settings and other
- 24:32models of secondary osteoporosis,
- 24:34and she has had a longstanding
- 24:37commitment to medical education and
- 24:39global health research training Evelyn.
- 24:45Thanks so much. Sad and thanks to
- 24:48everyone for inviting me to participate
- 24:50in this fantastic forum today.
- 24:52So let me just share my screen.
- 24:59Create and what are you seeing? I
- 25:02think if I go
- 25:04this way right that right?
- 25:07Yep OK so as Asad mentioned,
- 25:10I'm a rheumatologist specializes
- 25:12in musculoskeletal or immune
- 25:15conditions and I'm going to talk
- 25:18about a couple of things today.
- 25:21I'm going to talk about a few
- 25:23programs that we've been working on
- 25:25over the past several years that
- 25:27focus on training and capacity
- 25:29building in the area of rheumatology,
- 25:32and particularly in rheumatology
- 25:33research and and how these programs
- 25:35have branched out to intertwine with
- 25:37broader global health programs here,
- 25:39and I'd like to mention a new
- 25:42program that's coming down the road,
- 25:44which I hope others in the global
- 25:47health community here at Yale
- 25:49will be excited to be a part of.
- 25:51So just to give you a little
- 25:55bit of background,
- 25:57I think this is a common theme among
- 26:01many non communicable diseases globally,
- 26:04which is that there really
- 26:07has been in rheumatology,
- 26:09a significant lack of workforce
- 26:12and data and awareness among
- 26:16practitioners as well as public health.
- 26:19Missions and also patients about
- 26:22rheumatic diseases and so different.
- 26:25Cities may be at different
- 26:27points along the spectrum,
- 26:29but for rheumatology right now there
- 26:31is a significant shortage of awareness,
- 26:34information and training with regards
- 26:36to global rheumatology and so this is
- 26:39in stark contrast to what the you know
- 26:42numbers are showing us about global
- 26:44burden of musculoskeletal diseases.
- 26:46I don't think the the burden of rheumatic
- 26:50autoimmune conditions is well quantified,
- 26:52but in terms of muscoskeletal disease to WHO?
- 26:55Has recognized that the burden of
- 26:59disability for musculoskeletal
- 27:00disease is the leading cause
- 27:02and as well as chronic pain.
- 27:04So a few colleagues then I have been
- 27:08working closely with both the American
- 27:10College of Rheumatology and also the
- 27:13NIH Fogarty Global Institute for
- 27:15International Center and Niams to
- 27:18really try to bring more attention to this,
- 27:22and this is a figure from a
- 27:25paper we've just submitted.
- 27:27And is under review that demonstrates
- 27:29this vicious cycle that occurs
- 27:31when you have a group of conditions
- 27:34that there's a shortage in the
- 27:36workforce and patients are not
- 27:38getting access to care because of the
- 27:40shortage of workforce leading to,
- 27:42you know,
- 27:43under recognition of the mechanisms
- 27:45underfunding of trying to understand
- 27:47what the actual burden is,
- 27:49and continued misdiagnoses and so
- 27:50this is a number of individuals
- 27:53that start out with the diagnosis.
- 27:55The true number that are being recognized
- 27:58at the end of the day are really a time.
- 28:02A proportion,
- 28:03and this is closely linked with.
- 28:07So that's the backdrop of the health
- 28:09system where where medical access
- 28:12and services are being offered,
- 28:14and so policy and funding and
- 28:17infrastructure for research and
- 28:19education training play a critical role
- 28:22in trying to break this vicious cycle.
- 28:25And so this is sort of the challenge that
- 28:29our group has taken on an and hopes to,
- 28:33you know, make a change in going forward.
- 28:37So to.
- 28:39With that backdrop,
- 28:40I'll talk a little bit about a
- 28:43program that we've had in the
- 28:45rheumatology section at Yale.
- 28:47This started my work,
- 28:48as Todd mentioned his weekend osteoporosis,
- 28:51and as a global health.
- 28:54You know, as someone interested
- 28:56in global health since my medical
- 28:58school days back when I was
- 29:00training a lot of the global health
- 29:02training programs and infrastructure
- 29:04was really in the field of HIV,
- 29:07and so that's where my background came from.
- 29:09But when I became a rheumatologist,
- 29:12I was very interested in the overlap
- 29:14being sort of the synergistic
- 29:15problems of chronic infection and in
- 29:17chronic disease within patients who
- 29:20have longstanding chronic illness.
- 29:21And so a lot of my work focuses
- 29:24on osteoporosis and fractures.
- 29:26Among patients with HIV and so
- 29:29that brought me through a couple
- 29:32of different funding mechanisms
- 29:34that brought me to a partnership in
- 29:37China where I've worked since 2012,
- 29:40where where I'm part of a large,
- 29:44multicenter national program that
- 29:46looks at the impact of chronic HIV
- 29:49and antiretroviral therapy on the
- 29:52musculoskeletal health of patients.
- 29:54And while I was there, I became.
- 29:57Good friends with many colleagues
- 30:00in the rheumatology Department.
- 30:02Of course,
- 30:03I was thrilled to take part in their
- 30:06clinical rounds and, you know,
- 30:08get to meet their young trainees
- 30:10who are very bright and enthusia
- 30:12stick and we eventually ended up
- 30:15setting up this exchange program
- 30:17with medical students in China at
- 30:20picking in Medical College to come
- 30:22to Yale for two months in the summer
- 30:26to do an exchange program and.
- 30:28Part of it was of course to
- 30:31understand the medical system and
- 30:32medical education here,
- 30:34but also a part of it was to develop
- 30:36which I thought was important,
- 30:39was to develop some research training
- 30:41experiences that they weren't necessarily
- 30:43getting back in their medical programs.
- 30:45So you can see,
- 30:46these are pictures that I think a
- 30:48picture is worth 1000 words that these
- 30:51are some of the trainees that have
- 30:54participated over the years since 2016.
- 30:56It's just a few each summer.
- 30:59And I'll show you sort of the.
- 31:02You know the objectives of
- 31:04their work in the next slide,
- 31:06but you can see they've been able to
- 31:09participate in different kinds of activities,
- 31:12including getting to know New
- 31:14Haven and our famous pizza.
- 31:16But this has expanded over time,
- 31:18so it started out with the
- 31:21medical students from China,
- 31:23but it's expanded over time.
- 31:25We've had Yale students,
- 31:26undergrad medical students,
- 31:27and also alumni recent graduates who've
- 31:30been interested in work in China,
- 31:32and so they've.
- 31:33Obtained local,
- 31:34so the Chinese students obtain a
- 31:36local scholarship from there to
- 31:38come here and then in the Yale,
- 31:40students have obtained local
- 31:41funding to go to China or some of
- 31:43them who don't have the.
- 31:45You know, they don't end up going physically,
- 31:47but they still collaborate on a
- 31:49project and so you can see this
- 31:51is on the left bottom corner.
- 31:53This is a picture of a dinner
- 31:55with some of the Chinese visiting
- 31:57scholars were here mixed in with
- 31:59some of our own trainees here from
- 32:01Yale and some faculty as well.
- 32:03That's been really fun.
- 32:05We've also been able to expand
- 32:07to have some junior
- 32:08faculty who do exchanges and also now through
- 32:11the global HealthEquity Scholars Program.
- 32:13We've also included my early experiences
- 32:15in Global Health, took place in Peru,
- 32:18and so we've been very happy to set up a
- 32:21global HealthEquity Scholar site there,
- 32:23and you can see in the center
- 32:25panel this is Diego Cabrera.
- 32:27He came to Yale for a month last year at the
- 32:31beginning of his fellowship and was able to.
- 32:34Participate in a similar
- 32:37series of activities and so.
- 32:39You know when I think about this program and
- 32:42what some of the objectives are, you know.
- 32:45Concretely the participants are participating
- 32:47in summer didactic training that's available
- 32:49at Yale and clinical research and methods.
- 32:52I work with them to develop their
- 32:54research question of interest.
- 32:56Most of them go back and have a thesis just
- 32:59like our medical students have a thesis.
- 33:02They do as well,
- 33:03and so they use this opportunity to think
- 33:06about what their thesis project will be.
- 33:08An they perform a systematic.
- 33:10Literature review,
- 33:11which you know is a really valuable
- 33:14experience to them.
- 33:16They participate in summer clinical lectures.
- 33:20In rheumatology as well as in general
- 33:22medicine and they really get to
- 33:24learn about health care delivery
- 33:26in medical education in the US.
- 33:28Some part of that is through
- 33:31some shadowing experiences,
- 33:32but part of that is also through
- 33:34other fantastic lectures that
- 33:36are happening on campus.
- 33:37About you know medical education,
- 33:39about health,
- 33:40comparative health systems,
- 33:41and finally and one of the most important
- 33:43parts is engagement with other trainees,
- 33:46both local and international and
- 33:48in terms of some of.
- 33:50You know the things that we
- 33:52try to balance in this program,
- 33:55are you know the balance between
- 33:57didactic and hands on experience,
- 33:59and this is with regards to research methods.
- 34:02So really,
- 34:03you know,
- 34:03pushing them to think about developing
- 34:06a research question and how they would
- 34:08design their project around that question,
- 34:11we bounce between the experience you know,
- 34:13being shadowing or or in
- 34:15classes versus deliverables.
- 34:16You know, actually writing a protocol,
- 34:19for example, structured.
- 34:20Calendar versus time for, you know,
- 34:22independent meetings with,
- 34:24you know faculty or other student
- 34:26trainees who may be doing work that's
- 34:28of particular interest to them.
- 34:30And finally,
- 34:31a combination of mentored and peer learning.
- 34:33So there's so much that I find
- 34:36trainees learn from each other.
- 34:38And sometimes you know they're
- 34:39more willing to talk about,
- 34:41certainly obstacles with each other,
- 34:43and so I think that having the
- 34:46forum of students,
- 34:47both active students but alumni of
- 34:49you know who have been through.
- 34:51This exchange as well,
- 34:53it's been a really valuable forum.
- 34:57Uh, so uh?
- 34:58One of the things before I move on is
- 35:01that you know we're looking forward
- 35:03to hoping to expanding that program.
- 35:06Not just dermatology,
- 35:07but but to trainees in other
- 35:09specialties as well,
- 35:10and so that's one of the things that,
- 35:13in terms of future directions,
- 35:14you know I've been talking
- 35:16with the Office of Global
- 35:17Medical Education.
- 35:18Of course, because of Covid,
- 35:20so his plans have been on hold.
- 35:22But you know one thing that we think
- 35:25would be fantastic is to be able to,
- 35:27you know, brought in this
- 35:29experience that we've developed
- 35:30through the rheumatology program.
- 35:31To those who have, you know,
- 35:33other areas of interest as well.
- 35:36So the second program I'd
- 35:38like to talk about briefly is
- 35:40one that has not started yet,
- 35:43and this is the one that's
- 35:45coming down the line.
- 35:46This is called the China Medical Board
- 35:49Global Health Leadership Development
- 35:50Program and it will launch next
- 35:53year because we're not quite ready
- 35:55this year with the pandemic yet,
- 35:57but this is a partnership
- 35:59with the China Medical Board,
- 36:01so this is a Rockefeller Foundation
- 36:04endowed organization that
- 36:05strives to build capacity in.
- 36:07Professional education Policy
- 36:08Research and global health,
- 36:10and they have a strong focus on
- 36:14trainees in China and Southeast Asia.
- 36:18But because of the increasing presence
- 36:20that China has had in International
- 36:23Development and particularly in
- 36:25healthcare infrastructure development,
- 36:27one gap that has been recognized
- 36:30is that although there's a lot of
- 36:34expertise in building healthcare
- 36:36infrastructure in terms of,
- 36:38you know,
- 36:39trying to there really has been
- 36:42less expertise in the area of
- 36:45building sustainable public
- 36:46health and research partnerships.
- 36:49And so it's been exciting to be part of this.
- 36:53You know, not just yell,
- 36:55but also the London School of
- 36:57Hygiene and Tropical Medicine.
- 36:59We've been collaborating with
- 37:00them to create this program.
- 37:02Which will, you know,
- 37:04train young public health
- 37:06professionals and and health
- 37:07professions students from China to
- 37:09work in lower middle income country
- 37:11settings and part of their program.
- 37:14It will be modeled very closely.
- 37:16Actually after the global
- 37:18HealthEquity Scholars program said.
- 37:20I think Albert Co and Elsea wonder
- 37:22for all of their collaboration and
- 37:24input during the development process
- 37:26and also stand for month for his
- 37:29incredible support and guidance
- 37:31and so this program will bring
- 37:33trainees here to yell or to London
- 37:36for up to three months and then
- 37:38for the for the next nine months.
- 37:41Minimum is not in months.
- 37:43They will spend on the field really
- 37:46learning how to implement, you know,
- 37:48working closely with mentored.
- 37:50Sites to to learn about research
- 37:52but also program implementation
- 37:54depending on the background of
- 37:56this color and so this program.
- 37:58Like I said,
- 38:00it's just in the early administrative
- 38:02development stages now,
- 38:03but we're going to be excited to
- 38:06reach out to all the faculty who do
- 38:09amazing work around the globe to to see,
- 38:13you know if there are sites would be,
- 38:16you know,
- 38:17suitable for for participating
- 38:18in this program is.
- 38:20Would be interested in if they have
- 38:23opportunities so we have a few states
- 38:25that we've already been talking with,
- 38:28but we just we think there's a lot
- 38:31of opportunity here and I think
- 38:33you know from our perspective
- 38:35it's also important to really see
- 38:37the opportunities where you know
- 38:39the US is not the only funder
- 38:42of global development work,
- 38:43but that there you know in the world
- 38:46there are many potential sources
- 38:48and how we can work together.
- 38:51And how we can build the bridges that
- 38:53can really help provide you know,
- 38:55the support to do all the important
- 38:59work that needs to be done.
- 39:01And finally, I would be remiss if
- 39:04I didn't talk about engine and many
- 39:07of my colleagues in engine are part
- 39:10of this call Ann and I do want
- 39:12to talk about it because we are.
- 39:15We've been working on.
- 39:16This is the Yale Network for
- 39:18Global non communicable diseases.
- 39:20It's one of the faculty networks at
- 39:22the Yale Institute for Global Health
- 39:24and and we are really passionate about
- 39:27tackling different chronic disease issues,
- 39:30whether it's local or.
- 39:31International,
- 39:32but in communities where you know
- 39:35there's a real need for for this,
- 39:38and we think that sorry.
- 39:41Sorry.
- 39:46Sorry my son has to go back
- 39:47on his zoom class now so.
- 39:51So what I wanted to say about this is that
- 39:55so we were founded in 2015 and it's a.
- 39:59It's a Inter disciplinary group from
- 40:01different parts of the School of
- 40:04Medicine and the School of Public
- 40:07Health and we've had not just you know,
- 40:10faculty doing work in in our different sites,
- 40:13but also trainees and this picture
- 40:16down in the center lower Picture
- 40:18Panel is of two of our trainees.
- 40:21One from Ugandan went from Yale who
- 40:24worked on a project that was funded
- 40:26by one of Byg attacked awards in 2018,
- 40:29and we are very much looking forward to,
- 40:32and so I think one of the things
- 40:34that we find so important is the
- 40:37synergies that come from working in a
- 40:40multidisciplinary group and working with
- 40:42faculty and trainees across the spectrum.
- 40:44And one of our next phases
- 40:46will be expanding engine.
- 40:48It's been a little bit on hold
- 40:50because of the pandemic and then.
- 40:53People being pulled in many
- 40:55directions but but in May we will be,
- 40:57you know,
- 40:58trying to open this up and really invite
- 41:00faculty across the campus with interest.
- 41:02And so I wanted to mention that here
- 41:05because we do welcome people to join.
- 41:07Will be sending out more notices
- 41:09about that going forward all right?
- 41:11So I think those are the main programs.
- 41:14I just want to highlight to give a
- 41:16sense of you know what we've done
- 41:19and where we think we're going
- 41:21and how we hope to engage with.
- 41:23You know other people on this call and
- 41:26beyond in terms of capacity building,
- 41:28thanks.
- 41:31Thanks. So our next panelist
- 41:36is Doctor Christine Garia.
- 41:39She is a faculty member in
- 41:42emergency Medicine at the School of
- 41:45Medicine and her interests center
- 41:47on non communicable diseases,
- 41:50specifically on barriers to care
- 41:53and community based interventions
- 41:55with a particular focus on Africa.
- 41:58You know, past work has focused on
- 42:01health disparities amongst minority
- 42:03populations in the US and community
- 42:06based participatory research,
- 42:07which is particularly well
- 42:09suited for this kind of work.
- 42:12She was also a senior contributor
- 42:14to the first ever national study on
- 42:17non communicable diseases in Kenya,
- 42:20in which you know this study used a
- 42:23WHO validated national cross sectional
- 42:26study framework to assess the burden of.
- 42:29A burden and risk factors of NCD's,
- 42:32Ann and has contributed to work
- 42:35globally at the intersection
- 42:37of emergency care and chronic
- 42:39non communicable diseases.
- 42:41So over to you,
- 42:43Christine.
- 42:46Alright, just a moment. Give so much.
- 43:00Alright, I hope everyone can see my screen.
- 43:02OK so thank you for that kind introduction.
- 43:04I will try to be brief.
- 43:06I know we were given about 7
- 43:08minutes so I'll try to skip through.
- 43:10But again, I'm really just delighted
- 43:11to be here with this really esteemed
- 43:13panel and all the guests I can see.
- 43:15I think we have Doctor
- 43:17Frank Ninja back with us.
- 43:18Hi Frank, so excited to get
- 43:20through and hopefully get to
- 43:21some some questions at the end.
- 43:23These are some of my disclosures.
- 43:25Many things to Gli,
- 43:26the predecessor to wide ygh for
- 43:28this award that covers some of
- 43:30the work I'll be talking about,
- 43:32and the second grant covers
- 43:35some of my my current work.
- 43:37And of course,
- 43:38like Luke I I did want to start
- 43:40with a personal story which
- 43:42really informs what I do.
- 43:43Today.
- 43:44I was born in the US but raised
- 43:45in Kenya and then returned to
- 43:47the US for higher education and
- 43:49of course have stayed on at.
- 43:51Yale is a faculty member.
- 43:52After filling, finishing fellowship.
- 43:53But I now do most of my academic work.
- 43:56Actually in Kenya,
- 43:56which is also where the majority
- 43:58of my own global health capacity
- 44:00building efforts to occur.
- 44:02And in these kinds of
- 44:03talks, always like to give credit,
- 44:05because I really wouldn't be here today
- 44:07if it weren't for the amazing mentors
- 44:09and sponsors who've done their own
- 44:11individual capacity building in me.
- 44:12And it really comes full circle
- 44:14in terms of what these people
- 44:17have done in me thinking about my
- 44:19science and my role as an academic.
- 44:22And so just so we're on the same page,
- 44:25I wanted to share this definition
- 44:27that I feel encapsulates my own
- 44:30research capacity building efforts,
- 44:31which include thinking about both
- 44:34the individual and the institutional
- 44:36development in some of these countries
- 44:38with the aims of improving skills
- 44:40and ultimately hopefully increasing
- 44:42the quality research outputs.
- 44:44So, as was mentioned in my introduction
- 44:46and some of my capacity building has
- 44:49revolved around peer mentor ship.
- 44:51This is just an example from the Kenya
- 44:53Ministry of Health Project where I was
- 44:55working with some members from the
- 44:57government as well as community partners
- 44:59who do work on non communicable diseases
- 45:01in Kenya and as a senior collaborator.
- 45:04Of course I was working alongside
- 45:06these different team members who
- 45:07had varying levels of expertise in
- 45:09academic writing and research and
- 45:11so while I was excited to obviously
- 45:13contribute to four out of 10 of.
- 45:15These papers from this really impact study.
- 45:18I was even more keen and really
- 45:20encouraged to be working alongside
- 45:22them to conduct actual sub analysis
- 45:24and to write some of these papers.
- 45:27I've also had the opportunity to target
- 45:29junior faculty and research scientists
- 45:31both in Kenya and across the continent.
- 45:35And this has primarily been through
- 45:37conferences and symposia lectures on
- 45:39research and and also through developing
- 45:41leading an lecturing in a research workshops.
- 45:43So these are just a couple of research
- 45:46workshops that I've recently been
- 45:48invited to design and implement.
- 45:50One of them was with the emergency
- 45:53Medicine Kenya Foundation.
- 45:54Another was with the Kenya Society
- 45:56for Hematology and Oncology
- 45:57in collaboration with NCI,
- 45:59and the third one was last year via Zoom.
- 46:02As you can imagine.
- 46:04With the African Conference on
- 46:05Emergency Medicine and this is just
- 46:07an example of our impact to text.
- 46:09Might be a bit small,
- 46:11but we had nearly 300 participants
- 46:12that signed up for that pre Symposium
- 46:14workshop from across the continent.
- 46:16And so it was really delightful to
- 46:18see that there was some relevance and
- 46:21interest to be able to attend the
- 46:23conference workshop and it was well received.
- 46:26And then finally I think closest to my heart,
- 46:29and I think like it's been alluded
- 46:31to from some of the other panelists,
- 46:33I really mentoring of trainees and
- 46:35these junior people who are still
- 46:37early and budding in their careers
- 46:38is what I'm really passionate about
- 46:40and what that's looked like for me
- 46:42is really just being intentional
- 46:44with every project that I'm on.
- 46:46Every study that I'm a peon to really
- 46:48think about how to incorporate them.
- 46:51And So what are some of my outcomes?
- 46:53Well,
- 46:53these are two particularly good examples.
- 46:55I think of two separate groups of
- 46:57students I've closely mentored for
- 46:58the past three to four years around
- 47:00two different research projects.
- 47:02The group of young men on the left
- 47:04graduated Med school a couple of years ago,
- 47:07and so did the young woman on the right.
- 47:09The young man I actually met
- 47:11at a conference in Germany,
- 47:13a global conference there,
- 47:14and we started working on a
- 47:16project shortly thereafter.
- 47:17In 2018, at Presidents always
- 47:18inaugural trip to Africa,
- 47:20for which I was so lucky to be one of
- 47:22two yellow faculty delegates to attend,
- 47:24I was able to invite them to an event
- 47:26with him, and of course he would.
- 47:28They were just delighted to
- 47:30to meet President Salvey,
- 47:31the young woman on the right.
- 47:32I coincidentally actually
- 47:33met at the same event,
- 47:34and they actually came up to me
- 47:36and asked if I would mention them.
- 47:38And of course, I said, sure,
- 47:40and so some of our outcomes.
- 47:41Well,
- 47:42we actually have two different
- 47:43articles right now in press,
- 47:44one with applause,
- 47:45one and one with after the African
- 47:47Journal of Emergency Medicine.
- 47:48The young men highlighted in the
- 47:50picture you can see underlined
- 47:51and similarly for the young women
- 47:53and we continue to stay in touch.
- 47:55I've written letters of
- 47:56recommendation for them.
- 47:57They've gone to a variety of positions.
- 47:59This is just an example
- 48:00of one of the trainees,
- 48:02Thomas,
- 48:02who messaged me about a month ago
- 48:04because he wants to go into surgery
- 48:06and he went on to publish this paper
- 48:08and the surgical Journal which he
- 48:10was obviously very excited about
- 48:12and one of the people who is not
- 48:14featured in the other pictures but
- 48:16was actually a member of both of the papers.
- 48:18Oh,
- 48:19and that was funded by the Heck Talbar award.
- 48:21Is this young woman a doctrine bother wambua,
- 48:24and she was actually able to come to Yale.
- 48:27And this is actually a picture from
- 48:29an event organized by an Kellett.
- 48:31Thanks,
- 48:31Anne,
- 48:32with a few other trainees who are
- 48:34on campus at the time and she's
- 48:36going on actually to do residency
- 48:38in emergency medicine in Tanzania.
- 48:40You know,
- 48:40rest in peace to to their president today,
- 48:43but she's going to be going back to Kenya.
- 48:46Actually,
- 48:46as the second ever emergency
- 48:48medicine trained consultant.
- 48:49In the country which I'm just
- 48:50so delighted for,
- 48:51and I'm happy to play a very tiny role and.
- 48:54As far as there being a sort of a
- 48:56method to the madness with onboarding
- 48:57and mentoring these Chinese,
- 48:59I do have a system I'm not going
- 49:00to spend a lot of time with it
- 49:02now on it now because of the time,
- 49:04but I'm happy.
- 49:05I'm just I wanted to put this
- 49:06slide up just to make it available
- 49:08to others if they're interested
- 49:09in thinking about going through
- 49:10this or or if we have time to
- 49:13talk about it in the Q&A session.
- 49:16And then the last thing I was
- 49:18asked to mention
- 49:19was this final effort,
- 49:20which is an organization called Kenyan
- 49:22Doctors USA that I founded in late 2019,
- 49:25and my objective in starting this
- 49:26organization was really to augment
- 49:28some of the individual work that I've
- 49:30been doing around clinical research
- 49:32and educational capacity building,
- 49:33and really just given more of a
- 49:35framework in an infrastructure and to
- 49:37allow for other partnerships outside
- 49:39of just my own individual work.
- 49:41And so I co-founded it with
- 49:43some colleagues in the US,
- 49:44another one who actually happens
- 49:46to be at Yale.
- 49:47In surgical residency and we partner
- 49:50with organizations in Kenya with
- 49:51similar missions and did so with
- 49:53the Medical Student Association of
- 49:55Kenya and we're fortunate enough
- 49:57to be awarded a consortium of
- 49:59universities for Global Health.
- 50:01Tom Hall Grant in late 2020,
- 50:03and so we have the aims of using this
- 50:05grant to implement the first ever
- 50:08national Medical student Journal called
- 50:10Repub and also to design an implement,
- 50:13a parallel curriculum that will
- 50:15do some research training for
- 50:16students across the country.
- 50:18And as a third compliment to that
- 50:20intervention to do some internal
- 50:22mentorship for the peer review team.
- 50:25So we'll have senior consultants and
- 50:27faculty as senior viewers and medical
- 50:30students as your viewers and of course,
- 50:32will evaluate each of
- 50:34these three interventions.
- 50:36And the last thing for future work
- 50:38I've been working with a couple
- 50:40of colleagues actually in the
- 50:41call for the past couple years,
- 50:43sort of interrupted by covid,
- 50:44is to implement and NCD research capacity.
- 50:47Building intervention for clinicians.
- 50:48Scientists like the ones I've mentored on
- 50:50my own, maybe through a D43 if available,
- 50:52or another grant opportunity.
- 50:55And so just in closing for me,
- 50:57you know what?
- 50:58What motivates me and hopefully
- 51:00motivates others on the call that
- 51:02might be thinking about doing more
- 51:03of their own capacity building is
- 51:05really this global citizenship.
- 51:07I think that has been so evident
- 51:09over the past year,
- 51:10especially in its importance.
- 51:11Just an ethical obligation to advancing
- 51:13research opportunities equitably.
- 51:14And, of course, selfishly.
- 51:16I think,
- 51:16as we all know,
- 51:18there's this personal enrichment and
- 51:19fulfillment from getting to establish these
- 51:21relationships and watching people grow.
- 51:23And then the academic success that.
- 51:25I think does come out of establishing
- 51:27and building these relationships and
- 51:28the various work that comes from
- 51:30that and so with that I will stop and
- 51:33I'll be happy to take any questions.
- 51:34Thank you.
- 51:36Thank you so a few things.
- 51:38You know there are a few questions out there
- 51:41and I'll add a couple of my own questions,
- 51:45but I really appreciate everyone providing an
- 51:48overlapping but perspective on a few themes,
- 51:51but also their own distinct experiences.
- 51:53I think I think that shows the richness
- 51:56of global health capacity building
- 51:58that is happening across Yale,
- 52:00especially around the three
- 52:02Health Sciences schools.
- 52:04So a couple of questions look,
- 52:06there was a question for you to say you know,
- 52:10to talk about, you know a few examples
- 52:13of how you have seen implementation.
- 52:16Science approach is paying off in ways
- 52:19that might not have been possible,
- 52:21for example or slower.
- 52:23You know if traditional research
- 52:25methods had been used.
- 52:29Right, thanks? I mean,
- 52:30I think traditionally the model
- 52:32of research development is that of
- 52:34a pipeline where stage one stage,
- 52:36two stage three and implementation
- 52:37only comes in as a concern at the end.
- 52:40And I think Covid is provided many examples.
- 52:43The vaccine success probably the best one
- 52:45of the advantage of trying to move forward,
- 52:48and I think there's both successes
- 52:49and failures in that arena in terms of
- 52:52understanding implementation earlier and
- 52:53so from a methodological perspective
- 52:55we talk about hybrid studies where we
- 52:57are looking from the very beginning at.
- 53:00Not only what is the effectiveness of
- 53:02the interventions were developing,
- 53:04but how acceptable they are,
- 53:05and I've just seen that accelerate
- 53:08so much in my field,
- 53:10in diagnostics and around 2008 I had
- 53:12a chance to participate in an expert
- 53:14group panel at the becho to guide
- 53:17TV diagnostic policy.
- 53:18At that time there had been exactly 1
- 53:21recommendation and TB Diagnostics in
- 53:23the in the previous time immemorial,
- 53:25and since that time I think we're
- 53:28up to something like 20. Different.
- 53:32Statements now,
- 53:33and that acceleration really has
- 53:35benefited from just what I'm talking
- 53:36about now.
- 53:37Having people think not only about
- 53:39what's the diagnostic performance,
- 53:40but what are the profiles that
- 53:42we're looking for.
- 53:43What are the experiences that patients have?
- 53:45How do clinicians use those to make
- 53:48decisions so that setting just one
- 53:49brief example and there's lots of
- 53:51more specific examples from the
- 53:53different work that many of my
- 53:55colleagues have done in Uganda?
- 53:57So that's excellent,
- 53:59so there's another interesting
- 54:00question at any one of you can take it,
- 54:03or multiple people can briefly answer the
- 54:05question that comes from stende instead.
- 54:07Worm and sort of.
- 54:09You know there are different
- 54:11models of global engagement.
- 54:13And that there's a you know,
- 54:16especially in the context of yields
- 54:19footprint honestly being smaller
- 54:20than many other peer institutions.
- 54:23And we do not have as many large
- 54:26grants like PEPFAR USAID projects,
- 54:29you know, large project program
- 54:31project grants as an institution,
- 54:33and that's not restricted to global health.
- 54:36That is true,
- 54:38especially in comparison with our enormous
- 54:41success as an institution in getting.
- 54:43Other NIH and other really
- 54:46competitive grants, and so.
- 54:47So how do we any talks about how do
- 54:52we go about building that footprint?
- 54:55Should we sort of align these
- 54:58interests around a specific
- 55:00topic area or a specific country
- 55:03so we have presence in Liberia,
- 55:05Uganda, Pakistan, etc.
- 55:07You know several places etc.
- 55:09Or should we just forgo this and but
- 55:12overall focus on like institutionally,
- 55:15you know what direction should we go in?
- 55:19And or we should let the investigator
- 55:21and collaborator collaborator
- 55:22driven things percolate,
- 55:23and then see how things get
- 55:25aligned and so and so forth.
- 55:27So would love to hear people starts I,
- 55:30you know,
- 55:31I have some perspective on this as well,
- 55:33which in the interest of time
- 55:35I will refrain from expressing.
- 55:37You know,
- 55:37a lot of you on this panel
- 55:40know some of those thoughts,
- 55:42but but I think I'm genuinely interested
- 55:44in hearing what the panelists
- 55:46have to say around this topic.
- 55:48So Christina you were raising your hand.
- 55:51Well, I was. I have two kind of
- 55:54ways to think about this. One is.
- 55:57Anne. We at that this is what
- 55:59Assad alluded to at the beginning.
- 56:03So over the past year and a half,
- 56:05the team, that of which I'm a part at
- 56:08Yale University Librarian Vanderbilt,
- 56:10has been working on applying for
- 56:12a $15 million USAID grant to do
- 56:14capacity building work in Liberia,
- 56:16and we were recently notified that
- 56:18we've been recommended for funding,
- 56:20which is very exciting.
- 56:21An in the process of doing that,
- 56:24I learned that it at Yale.
- 56:26There is only one other USAID grants
- 56:29admitted in the last five years.
- 56:31Which was really surprising,
- 56:32and so I think this speaks to
- 56:35the point that Stan is raised.
- 56:37This is another mechanism of funny,
- 56:39very different from NIH in
- 56:41every imaginable way.
- 56:42But you know,
- 56:43part of what I think has put us in a
- 56:46position to be successful is that we
- 56:48had this very strong trusting working
- 56:51relationship with our partners in Liberia,
- 56:54particularly Doctor Don,
- 56:55whom I mentioned briefly
- 56:56in my introductory slides,
- 56:57who is very, very senior.
- 56:59She was a Minister of Health.
- 57:01Now she's a.
- 57:02Basically a vice chancellor at the University
- 57:04of Liberia overseeing all of Health Sciences.
- 57:07So I think we might want to think
- 57:09differently about our existing partnerships.
- 57:11I mean,
- 57:11there's no chance at all that I
- 57:13alone would be positioned to get
- 57:15any kind of grain of this size,
- 57:17but because we were so closely
- 57:19working with these partners in
- 57:20Liberia and have such a strong
- 57:22team really trusting team and
- 57:24also partners at Vanderbilt.
- 57:25And we just have worked together
- 57:27so well for such a long time.
- 57:29We had that to offer and I
- 57:31think Yale has more of that.
- 57:33And can go for these kinds of grants.
- 57:36Maybe then we realized which
- 57:38just really quickly on the other.
- 57:40Thing I was going to say,
- 57:42as sod knows very well why Igh is
- 57:44actively working toward building
- 57:45this capacity at Yale through
- 57:47the faculty networks,
- 57:48Faculty Support Initiative,
- 57:49thinking creatively about what's
- 57:51coming down the line at some of
- 57:53the big funders and how we can
- 57:55position ourselves strategically
- 57:56to go for some of those awards.
- 57:58So in the interest of time,
- 58:00I'll stop there,
- 58:01but I think I think there's a lot
- 58:03that we can do to stems question
- 58:05to make a larger footprint.
- 58:07Building on the partnerships
- 58:09and expertise we already have.
- 58:11So maybe since you mentioned that
- 58:12very briefly, in 30 seconds,
- 58:14can you sort of elaborate on the
- 58:16faculty support initiative and how
- 58:17did it that some of the things that
- 58:20will be offered through that did that
- 58:22help you with this specific brand?
- 58:24Or what are some of the you know
- 58:26where things are going with
- 58:28the support services that are
- 58:30available for faculty that
- 58:31are submitting large grants?
- 58:32Sure, so through the
- 58:33Faculty support initiative,
- 58:34we're offering opportunities
- 58:35as I briefly mentioned,
- 58:36for people to get support,
- 58:38there's the faculty network,
- 58:39which is led by my colleague.
- 58:41Jeremy Schwartz scuse me,
- 58:43but we're also offering
- 58:44consulting Grant Consulting,
- 58:46which I was able to use as a Guinea pig,
- 58:49which worked out very well for
- 58:51large grant awards were doing grant
- 58:54searches where we just launched
- 58:56a website with all different
- 58:58kinds of resources for faculty,
- 59:00and so we're trying a multifaceted
- 59:02way of elevating faculty
- 59:03communications for faculty to help
- 59:05position people for success here.
- 59:07So out of five miss anything, feel free.
- 59:12No, this is this is good.
- 59:14You know, I think.
- 59:15Thanks for being brief.
- 59:17So for more details people couldn't go
- 59:19to the Yale Institute for Global Health
- 59:21website and get more information about
- 59:24both faculty networks that are that buy in.
- 59:26Coordinated by Jeremy Schwartz and the
- 59:29Faculty Support Initiative that is led
- 59:31by Christina Talbert Slagle who's here.
- 59:33So were you raising your hand or we
- 59:36just stretch stretch?
- 59:37Yeah yeah no I was just going to
- 59:39very briefly comment in response to.
- 59:42Guns question, and I think that you know.
- 59:46From the perspective of engine
- 59:48and and Christine and Tracy
- 59:50and Jeremy and Nikki Haley,
- 59:51I'm not sure if she's on this.
- 59:54They've all been key in.
- 59:56Sort of the developmental
- 59:58process of this network.
- 01:00:00And I think that's you know, sort of.
- 01:00:03One of the things that brings us
- 01:00:05together is that we really respect,
- 01:00:07and, you know,
- 01:00:08appreciate all the individual
- 01:00:10investigator driven projects.
- 01:00:11But we really also find the value
- 01:00:13of the synergies that come together
- 01:00:15when we are together as a group,
- 01:00:17and we're trying to think you know,
- 01:00:20beyond the individual countries
- 01:00:21and projects. I think
- 01:00:22that the group has been able to, you
- 01:00:25know, use this network,
- 01:00:26what you know to both focus on country,
- 01:00:29specific topic specific projects,
- 01:00:30but also. You know,
- 01:00:32think about how how we can be broader,
- 01:00:35and so this is sort of like a small
- 01:00:38model of what stands talking about,
- 01:00:40which is, you know,
- 01:00:42more the PEPFAR USAID type grants.
- 01:00:44But, but I would say that, you know,
- 01:00:47Yale doesn't have to give up the you know,
- 01:00:50rich investigator, driven,
- 01:00:51you know, type of work and success.
- 01:00:54You know, in pursuing these,
- 01:00:56these larger collaboratives ether,
- 01:00:57you know, I think that we should be,
- 01:01:00as Christina said, like.
- 01:01:02Benefiting from that rich
- 01:01:04experience to to kind of try to
- 01:01:06take our impact to the next level.
- 01:01:08It's just I think,
- 01:01:09the experience that you know
- 01:01:10from our networks perspective.
- 01:01:12I think with, you know,
- 01:01:14speak to that kind of vision.
- 01:01:16So yeah, so I will before we wrap up.
- 01:01:18I'll just give last question to Christine.
- 01:01:22I will then wrap up in the
- 01:01:25interest of time so you see there
- 01:01:27is a lot of you know your work.
- 01:01:30You uniquely qualified based on your
- 01:01:33experience and your work in terms of
- 01:01:36looking at equity and both in the US.
- 01:01:38But obviously global health work
- 01:01:40ethically done is sort of sits
- 01:01:42on a bed of understanding of
- 01:01:44inequities between countries,
- 01:01:45but also there's an increasing recognition.
- 01:01:48There has been there that even in MI seas
- 01:01:51there are structural disadvantages that are.
- 01:01:54Several subgroups have of the population.
- 01:01:57There are 20 different ways of being poor.
- 01:02:03ETC and so.
- 01:02:04Any thoughts on lesson learns that
- 01:02:06can cross fertilize our thinking both
- 01:02:08in the US and in LMS ease so so any
- 01:02:11quick thoughts before we wrap up?
- 01:02:13Yeah, just a quick quick comment
- 01:02:15on Alpha focus on
- 01:02:16gender because of the extent of time of time.
- 01:02:19I know it's odd you and I have
- 01:02:21talked about this in the past.
- 01:02:23I mean, I'll give a plug I think so I know
- 01:02:26you're thinking about this intentionally.
- 01:02:27I will also give a plug for women leaders in
- 01:02:30global health or women left global health.
- 01:02:32Excuse me, which I'm a cohort member
- 01:02:35and part of that I think is really.
- 01:02:37Affecting how we think about systems
- 01:02:38change also individual change and
- 01:02:40actually has a leadership development
- 01:02:41program they think is really going to
- 01:02:43breakthrough some of these barriers across
- 01:02:45country and a few other organizations.
- 01:02:46Women's group women lead women
- 01:02:48in global health.
- 01:02:48I think we're trying to think about this,
- 01:02:50but I think I think we have a
- 01:02:53potential way to think about this.
- 01:02:54For Tegic Lee offline side in
- 01:02:56terms of what can yell do in terms
- 01:02:58of affecting that strategically,
- 01:02:59there are a lot of different.
- 01:03:00Again, I've mentioned a few.
- 01:03:02The big ones that I think are doing it well.
- 01:03:04CJ as well I think as well.
- 01:03:07So what can we do as an institution
- 01:03:10to do this a bit better to advance
- 01:03:13women in particular
- 01:03:14equitably with their male counterparts,
- 01:03:16so that's excellent.
- 01:03:17So before I sort of wrap up and
- 01:03:20say a few things around this,
- 01:03:22Melanie Scion from surgery had a
- 01:03:24sort of comment slash question about
- 01:03:26implementation sized office hours Melanie.
- 01:03:29Let's connect offline.
- 01:03:30If there is a critical mass of people
- 01:03:33who are there, so there's something
- 01:03:35that ygh can potentially support.
- 01:03:37And work with various partners.
- 01:03:39Obviously you know with their
- 01:03:41engagement and interest,
- 01:03:42but if there is a critical mass of
- 01:03:44people who need that kind of input,
- 01:03:47help, support, etc,
- 01:03:48we can always connect offline.
- 01:03:50But to wrap up, look this is.
- 01:03:53A time I would say exciting time for
- 01:03:56global health because there is broader
- 01:03:59recognition out of a lot of this
- 01:04:02crisis around COVID-19 that exposed
- 01:04:04inequities within and between countries.
- 01:04:07There is a recognition that
- 01:04:09I have never seen before.
- 01:04:11The public health and global health
- 01:04:14broadly including clinical care
- 01:04:15for under resourced populations
- 01:04:17has always recognized that these
- 01:04:20inequities are in acceptable.
- 01:04:21But there is a broader recognition and
- 01:04:24when there is a broader recognition.
- 01:04:27There's an opportunity to act the
- 01:04:29way we act matters and the way we
- 01:04:33act as an institution ethically,
- 01:04:35sustainably.
- 01:04:35An impactful E would be determined by
- 01:04:38you know whether whether or not we are
- 01:04:41strategic and thoughtful about this,
- 01:04:43and I have a lot of confidence that
- 01:04:45the critical mass of people who are
- 01:04:48working within the year ecosystem
- 01:04:50on these topics bring that level of
- 01:04:53thoughtfulness and expertise to the
- 01:04:55topic and the sense of compassion.
- 01:04:58That which bodes well for yelan and
- 01:05:00frankly a lot of the emerging in
- 01:05:02your efforts build on the strong
- 01:05:04foundation provided by different earlier
- 01:05:07initiatives and ongoing initiatives,
- 01:05:09just like the one in the
- 01:05:11Department of Medicine.
- 01:05:12And I would single out.
- 01:05:15You know Tracy and and others who are in
- 01:05:19the current leadership of that initiative.
- 01:05:23But also my friend Oscar Rustica
- 01:05:26and he and others before alongside
- 01:05:29him played a huge fundamental role
- 01:05:33to creating that critical mass of
- 01:05:36initiatives that provide a platform us
- 01:05:40to build the build and expand what?
- 01:05:45What what you know has to bring to
- 01:05:47the table in this very important area.
- 01:05:49So with that, I'll wrap up the session.
- 01:05:53Great,
- 01:05:53thank you so much.
- 01:05:55Sad for moderating a wonderful session.
- 01:05:57Thank you also to doctors Talbert,
- 01:05:59Slagle, doctor, Shay, Doctor,
- 01:06:00Davison, Doctor and Gloria for your
- 01:06:02thoughtful comments and for sharing
- 01:06:04your amazing work with all of us.
- 01:06:06I know all of you well but but as I have
- 01:06:09said I learned quite a bit from today's
- 01:06:12presentation as well and look forward
- 01:06:14to moving forward together with you.
- 01:06:16Just as one last plug for our
- 01:06:19final Global Health Day event,
- 01:06:20I'm going to share our slide tonight.
- 01:06:23We have our fifth annual.
- 01:06:25Refugee health education conference.
- 01:06:26Physical and mental health of
- 01:06:28refugees the COVID-19 update.
- 01:06:29This QR code will take you directly
- 01:06:31to the website where you can register
- 01:06:34to attend or you can visit the link.
- 01:06:36We look forward to seeing you there.
- 01:06:39This will be our final event for Global
- 01:06:41Health Week and Global Health Day of 2021.
- 01:06:44So thanks so much to everyone for joining
- 01:06:47us and I look forward to seeing you soon.
- 01:06:50Take care.