Global Health Imperatives
CGH's imperatives advance care and research focused on reducing current and growing global disease burdens, such as in oncology, infectious disease and women's health, and in accelerating the pace of biomedical innovation in under-resourced settings through rapid biomedical technology adaptation and use.
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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.
Penn has a strong clinical and research focus on women's wellness and pediatric care. Our clinicians, educators and researchers are engaged in these life-saving and high-impact arenas both domestically and abroad. In addition, the Center for Global Women’s Health (CGWH) is an interdisciplinary effort based in the School of Nursing that brings together faculty and students who collaborate on women's health scholarship, education, and clinical practice relevant to global issues.
Mobile health (mHealth) uses mobile technologies as tools and platforms for health research and healthcare delivery. mHealth tools or interventions can prove particularly useful in low resource settings, to address chronic disease or an array of other health issues, emphasizing the evaluation of health-related outcomes. The Penn Medicine Center for Health Care Innovation oversees the work of the Penn Social Media and Health Innovation Lab, an entity that conducts and disseminates multidisciplinary research at the intersection of social media, mobile technology, and health. mHealth Labs brings together medical, engineering and nursing students to work together to develop and test technologies to improve health care delivery.
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.