Global Health Imperatives
CGH's imperatives advance care and research focused on reducing current and growing global disease burdens, such as in Cardiology, Oncology, Infectious Disease, Genetics & Health Equality, Dermatology, and Emergency Medicine.
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Penn’s Department of Emergency Medicine (EM) strives to be leaders in generating new approaches to improving patient outcomes. They are proud of the deeply collaborative and impactful work led by the physician-scientists in the department. Penn EM has a broad research portfolio spanning translational resuscitation science, health policy, economics, toxicology, and ultrasound, as well as social media.
In recent years Penn EM has invested heavily in expanding its global reach, one such effort has been the establishment of the Penn Global Emergency Medicine (PGEM) Fellowship, which seeks to prepare leaders in the field of Global Emergency Medicine in emergency care systems development and education. Beyond the establishment of the PGEM Fellowship, Penn EM faculty and collaborators have worked in countries such as Ghana, Pakistan, Guatemala, and Nepal, providing clinical care, establishing training programs to meet local needs, and preparing health care providers to respond to emergencies, such as the COVID-19 pandemic.
CGH, in concert with the Abramson Cancer Center, has identified oncology as a keystone global health initiative. In that context the Center is engaged in a series of programs to develop oncology diagnosis, treatment, longitudinal care and training programs at multiple international locations, with primary focal points based in Botswana, working in support of the Partners in Health oncology mission in Rwanda, and most recently in Guatemala.
Led by Dr. Larry Shulman, Director of Global Oncology, our efforts in Botswana, Rwanda and Guatemala seek to improve clinical care at hospitals. While Botswana and Rwanda focus on national capacity building, Guatemala represents a community-based effort.
Key focus areas in global oncology include:
- Refine development of oncology clinical services via care guidelines and protocols, lab diagnostics, drug formularies and procurement and related technology development at US standards, but scaled to the local population needs and resources
- Establish bidirectional oncology training programs that serve as a base for nurturing nurses and physicians with expertise in oncology who will be located in their home locations
- Develop research protocols that track patient outcomes based on care guidelines that provide additional information on distinctive genetic and environmental conditions which may dispose to cancer types
- Extend oncology programs from central locations to additional urban and/or rural settings, as appropriate
Oncology Initiatives in Botswana
Following the AIDS/HIV epidemic in sub-Saharan Africa, oncology has emerged as a central health burden within the area of non-communicable disease. Penn, via the Botswana-UPenn Partnership (BUP) has been working with both the Botswana Ministry of Health and Wellness and the University of Botswana on broad issues of clinical care, education, and research.
With the support of the Department of Radiation Oncology at Penn, Dr. Surbhi Grover has been based in Botswana full-time since 2014. Under her leadership, numerous Penn faculty and trainees in oncology have supported research and clinical initiatives in Botswana, such as the following:
Direct clinical care
Dr. Grover is the head of oncology at the Princess Marina Hospital, the largest tertiary public hospital with the largest public department in the country. Working closely with local clinicians, she has been instrumental in establishing new patient clinic for teaching and established evidence-based care for all patients seen in clinic, in addition to establishing a follow up clinic for gynecological cancer patients to help manage toxicities post oncological treatment.
In addition to direct clinical care, Penn oncology and pathology teams are working with collaborators at Princess Marina Hospital and the University of Botswana on programmatic initiatives to define treatment protocols, eliminate aligned chemotherapy stockouts, and improve delays in pathological diagnosis of cancers through collaboration with the American Society of Clinical Pathology.
The Penn Department of Radiation Oncology and the University of Botswana have multiple funded research grants including through the National Cancer Institute, the Center for AIDS, and the Union for International Cancer Control. Research includes the natural history of cervical cancer and capacity building in both basic and clinical research. BUP leaders have helped support young investigators in oncology and link them with mentors both in Botswana and the US, and Penn faculty have rotated in Botswana to provide on-site mentorship and advanced clinical training.
Numerous Penn faculty, who also serve as adjunct faculty at the University of Botswana, are involved in training junior faculty at the University of Botswana on research methods in oncology.
Penn has worked with the University of Botswana School of Medicine to enhance their residency program in medicine and to establish a radiation oncology rotation in Botswana for residents in the US. This enables senior residents the opportunity to provide clinical care in Botswana, while fostering their involvement in global health.
Technical Assistance to the Botswana Ministry of Health and Wellness
Penn oncology faculty work closely with leadership at the Princess Marina Hospital and the Ministry of Health and Wellness to develop cancer guidelines for the top 10 cancers in Botswana, in addition to providing technical input for the establishment of the new radiation oncology facility at the University of Botswana.
Oncology Initiatives in Rwanda
The Cancer Center of Excellence in Butaro, Rwanda, established by our key partner, Partners in Health is Rwanda’s first facility dedicated to cancer care and represents a model of what rural health care should look like. Built in the highlands of northern Rwanda in 2012, the hospital now provides high-quality cancer care to 1,500 patients a year. It also serves as a national cancer referral center as we support the Ministry of Health’s effort to develop cancer centers in other referral hospitals around the country.
Efforts in Rwanda include building pathology capacity, including an on-site lab, which has resulted in shorter diagnostic wait times. Oncological training has been a major focus at Butaro; physicians, residents and nurses from across Rwanda engage with experts from Penn, Harvard and Dartmouth University. Finally, PIH drives outreach and empowerment in remote communities through a sizeable contingent of community health workers who offer preemptive screenings and health education materials.
Genomics & Health Equity
Penn’s Department of Genetics is at the forefront of genetic research and advancements in health. The Department of Genetics among many others work with The Penn Center for Global Genomics & Health Equity. Whose mission is to promote health equity through global genomics research, education, policy, and practice. The purpose of the Penn Center for Global Genomics and Health Equity is to facilitate understanding of genetic and environmental factors influencing health disparities in the US and across the globe through interdisciplinary collaborations, partnerships, and education. These findings will be translated into public policy and clinical practice to promote health equity.
Despite a high global burden of skin disease, there is a critical shortage of dermatologists worldwide. Access to dermatologic care is particularly scarce in low-resource settings, where the confluence of infectious diseases including HIV, chronic inflammatory dermatoses, and cutaneous malignancy causes significant morbidity. With the support of the CGH, the Penn Department of Dermatology, the Kramer family, and other generous collaborators, faculty are working with partners in multiple sites to expand access to quality dermatologic care in vulnerable populations locally and abroad. Key focus areas include: forming long-term partnerships, supporting local providers and systems, education and capacity building, direct patient care, research, and leveraging technology to decentralize care.
Penn dermatology has been active in Botswana since Dr. Carrie Kovarik started the program in 2007. In collaboration with the Botswana-UPenn Partnership and the Botswana Ministry of Health and Wellness, Dr. Amy Forrestel, Dr. Tori Williams, and Dr. Kovarik have worked to assist in running the dermatology clinic at the central government tertiary hospital, expand outreach clinics, create teledermatology networks, train local students and providers, and create a sustainable local dermatology team. Drs. Kovarik, Forrestel, and Williams are also the directors of the American Academy of Dermatology’s Resident International Grant, which began in 2008, and funds educational exchanges with partner institutions in Botswana, South Africa, Nepal, and Peru.
In Peru, Dr. Rudolf Roth has with the Gorgas Memorial Institute of the University of Alabama, the Alexander von Humboldt Tropical Medicine Institute, and the Dermatology Department of the Universidad Peruana Cayetano Heredia to develop the Gorgas Course in Tropical Dermatology. This week-long course is designed to teach providers from around the world about tropical dermatology. In Guatemala, Dr. Roth has worked with the Penn-Guatemala Health initiative and colleagues from the Instituto de Dermatología y Cirugía de Piel (INDERMA) to build a residency exchange program. In Haiti, Dr. Roth helped create an agreement between Penn and the state hospital in Port-au-Prince (Hôpital d l'Universite d'Etat d'Haiti) that allows bilateral exchange of any department, including dermatology.
Finally, the department is dedicated to educating Penn residents in global health dermatology. In the formal residency track “Global and Community Health,” residents are able to learn about and participate in caring for vulnerable populations through a structured curriculum involving clinical rotations, lectures, and mentorship.
The Penn ID Division is recognized for excellence in clinical care, research, and education. The expertise of the Division's faculty is complementary to our strong inpatient and outpatient programs in HIV medicine; infections in solid organ and bone marrow transplant recipients; healthcare epidemiology and antimicrobial stewardship; antimicrobial resistance; viral hepatitis; tuberculosis; travel medicine; and global health. In addition, our faculty are nationally and internationally renowned leaders in scientific investigation including bench science, translational and epidemiologic research, clinical trials, health policy, and public health. Our faculty are also known for their teaching excellence, traditionally capturing numerous School of Medicine teaching awards each year. In addition, the success of our faculty is recognized by the fact that numerous individuals hold leadership positions within national and international organizations, guidelines panels, and scientific committees. While most faculty members are based in Philadelphia, many are also based abroad, primarily within the Botswana-University of Pennsylvania Partnership, a unique multi- and inter-disciplinary clinical and research collaboration.
CGH, in concert with the Penn Cardiovascular Medicine Division, has identified cardiology as a keystone global health initiative. In that context the Center is engaged in a series of programs to develop cardiovascular (CV) diagnosis, treatment, longitudinal care and training programs at multiple international locations, with focal points based in Haiti, Jamaica and Mexico.
Led by Dr. Marietta Ambrose, Director of Penn Cardiology International (PCIL), our efforts at these locations seek to improve clinical care at hospitals and national capacity building.
Key focus areas in global CV care include:
- Refine development of CV clinical services via best practice and care guidelines and protocols, lab diagnostics, drug formularies and procurement and related technology development at US standards, but scaled to the local population needs and resources.
- Establishing innovative bidirectional CV training programs that utilize both traditional and modern virtual educational techniques. This serves as a foundation and base for nurturing physicians, physicians in training, nursing and other allied healthcare professionals with expertise in cardiology who will be located in their home locations.
- Developing research and monitoring protocols that track patient outcomes based on established standards of patient care and guidelines, to provide additional information on achieving metrics associated with desirable clinical outcomes and patient safety.
- Extend cardiology programs from central locations to additional urban and/or rural settings, as appropriate.
CARDIOLOGY INITIATIVES IN JAMAICA
PCIL has partnered with the Heart Institute of the Caribbean (HIC) in Jamaica. HIC was founded in 2004 by Dr Ernest Madu, an internationally recognized authority in CV medicine and innovative healthcare solutions, who has led multiple transformational health care projects that bridge gaps in access to quality health care delivery in Africa and the Caribbean. Prior to HIC’s inception, many patients in Jamaica, in need of a higher level of care for cardiovascular disease (CVD) had to travel at great expense to the USA or other countries with more developed health care infrastructure. HIC provides more advanced care for CVD, occupational health, diabetes care and general internal medicine in the West Indies, so patients can remain home while receiving this care. They also provide more than $1 million in free or reduced care to patients, a significant contribution in an area where 56% of hospital deaths are caused by CVD. PCIL delivers CME accredited advanced congestive heart failure (CHF) education and training to their cardiologists and staff. The goal is to create a robust advanced CHF program at HIC that can serve Jamaica and the larger Caribbean region’s clinical care, future research and education.
CARDIOLOGY INITIATIVES IN MEXICO
PCIL has partnered with the Instituto Nacional de Cardiologia Ignacio Chavez; also known as the National Institute of Cardiology of Mexico, and more informally called the Mexican Heart Institute. The Mexican Heart Institute was founded in 1944 by Dr. Ignacio Chavez. PCIL delivers advanced congestive heart failure (CHF) and cardiothoracic (CT) surgery education and training to their cardiologists, cardiothoracic surgeons and staff. The goal is to create robust advanced CHF and CT surgery programs that focus on integrating state-of-the-art, novel device therapeutics, to improve clinical outcomes in patients who have failed recommended medical and pharmacologic therapeutic interventions. PCIL continues to investigate more partnerships in other Latin American countries while partnering locally with pediatric cardiologists and CT surgeons at Children’s Hospital of Philadelphia (CHOP) to address their more unique needs in projects related to pediatric cardiology and adult congenital heart disease.
CARDIOLOGY INITIATIVES IN HAITI
PCIL has partnered with the L’Hôpital Universitaire de Mirebalais (HUM) in Haiti, one of 4 teaching hospitals with residency programs. Haiti is considered by the World Bank to be the “poorest country in the Latin America and Caribbean region and among the poorest countries in the world” and CVD accounts for 29% of all deaths. There are very few physicians and approximately 16 cardiologists serve a country of 11+ million people. Given the deficiency of cardiologists and training opportunities for Haitian physicians, in the setting of a high burden of CVD, Dr Norrisa Haynes has been addressing this disparity as a member of the PCIL team. Through her interests in global health activities and medical education, Dr Haynes previously lived in Haiti and was a staff physician at HUM. She has continued this relationship to help create an international, high-quality, sustainable and capacity-building cardiology curriculum for physicians in training, called ICARDS-HAITI. This unique educational collaboration benefits from a partnership between Haitian, American and French academic cardiologists in its design, development and implementation. Hence this curriculum was tailored to the unique needs of Haitian providers in a low-resource setting. This project continues to expand and now involves multiple other hospitals in Haiti, receives active participation from Haiti’s local community of cardiologists and the involvement of the Haitian society of cardiology. We plan to grow and diversify the curriculum to deliver more cardiology education and training in other areas of need.
CARDIOLOGY INITIATIVES IN VIETNAM
Although there are currently no active programs in Vietnam, PCIL has a large footprint in this country. PCIL was previously part of a larger effort to develop a regional center of excellence in CV medicine, intervention, and research. This involved creation of institutional-specific protocols, designing and creating optimal physical infrastructure for integrated multidisciplinary CV care, targeted, individualized CME certified education of health care providers with traditional, in person onsite and virtual educational methods including training courses. PCIL had staff cardiologists who were dedicated to this project, stationed onsite and based in Vietnam. The COVID-19 pandemic unfortunately affected this program, but we are keen to see what the future will bring.