Global Health Webinar

Paula Mazilla: Care around the world. My name is Paula Mazilla and I will be today's moderator. I am a public health career services coordinator and advisor here at USC, and I hope to see all of our students coming to my office or make an appointment to meet online, and I have been in public health for the past 15 years. I am trained in epidemiology, and have done work with non-profits in HIV and STDs. I have also done some research here at the school of Public Health around cancer and some [inaudible 00: 00: 48] research, and let's move on to the agenda.

So, today, I would like to notify everyone that today's panel presentation is being recorded, and it will be available in the next couple of weeks to all of the students. Some housekeeping items. Please, mute your phone lines. If you have any questions, please type them in the chat box, which I saw some of you were already using, and also we will make the presentations and recordings available in a couple weeks. Now, just I'm having some technical difficulties. My Adobe Connect is disconnected. Okay. Let me try that again.

Okay. Sorry, my Adobe Connect is connected. Well, let's start by introducing, we are going to introduce Jarrod Chin who serves as a director of diversity, and inclusions of partners in health. In his role he is responsible for developing, implementing, and evaluating all diversity inclusion strategy. Jarrod would you like to say hello and tell us something briefly about yourself? Jarrod? I think we've lost Jarrod. Hi. Jarrod. Is that you?

Jarrod Chin: It is now. Yep. We're back.

Paula Mazilla: Hi. Yeah, I had some ... Adobe Connect disconnected me. I was saying, Jarrod, would you like to say hello and tell us briefly something about yourself?

Jarrod Chin: Well, my name is Jarrod Chin, I guess, and I'm cold. We're all in Boston right now and it's below freezing out, and we just saw snow. So, thinking about you all in Southern California makes me jealous, I guess.

Paula Mazilla: Yeah. It's not that warm today, but thank you so much Jarrod. Next we would like to introduce Dr. Annie Michaelis, and I apologize if I tortured your last name. She is currently the director of the monitoring, evaluation, and quality improvement team with Partners in Health. She provides technical support for quantitative and qualitative data utilization, information system strengthening, and operation research efforts across a wide range of healthcare service delivery programs. Dr. Michaelis, would you like to say hello and tell us briefly something about yourself?

Annie Michaelis: Sure. Hi, everybody. Like you said in the little introduction, I am the director of what we call the MAQ team here at Partners in Health, and yeah I guess later on in the presentation I will tell you a little bit more about my trajectory in public health, but yes, glad to be here today.

Paula Mazilla: Thank you, and again I will apologize if I get this name wrong. Faisal Zareen is the associate director for Grants management for Partners in Health where he is leading the contractual management and absorbed compliance for CDC, EU, UMVP, UNSS, and OSDA funded projected Sierra Leone, Labëria, and Kazakhstan. He specializes in field of non-profit welfare, humanitarian relief, and disaster management. Faisal would you like to say hello and tell us something? Are you there?

Faisal Zareen: Paula, thank you so much. I can confirm, you did not torture at all my name. You did really well. Hi everyone. I am Faisal Zareen. I represent the grants management team in Partners in Health, obviously very excited to be with you here today, and look forward to our chat as the session progresses.

Paula Mazilla: Great. Thank you, and finally we have Milenka Jean-Baptiste works as a project manager, clinical research associate at Partners in Health, working primarily with underserved communities both within the US and globally. Mrs. Jean-Baptiste brings 10 years of experience implementing and supporting the development of public health programs and research around HIV prevention and maternal child health intervention. Milenka, would you like to say hello, and I apologize if I said your name wrong.

Milenka J-B: Hi, you're perfectly fine. I think I'm very used to my name being changed a little bit, but the way you pronounced it was perfect, actually. So, my last name is pronounced Jean-Baptiste and it's of Haitian origin. You gave a great background for me, and I look forward to speaking with folks a little bit more about my career trajectory in public health. One small thing about me right now is that I'm just getting over a cold. So, you'll have to forgive me if I fumble my words a little bit.

Paula Mazilla: Okay. Thank you. Okay, so now we are going to ... next on our agenda is the P.I. Age overview of the agency. So, Matt will be switching the presentation.

Jarrod Chin: Great, thanks Matt. I'm not sure if people can raise their hands, or if people can type down below, but are people familiar with Partners in Health? Those who are alive, you can type in the chat box or even up on the top screen up here. All right. Good. So, a lot of folks are familiar with Partner's in Health. Great. So, I'll just briefly then go through what Partners in Health is all about.

I think it's really more important that you hear from Milenka, Annie, and Faisal about the work that they do, and I'll kind of step to the side and let the experts do their thing. So, PIH is working to dismantle the double standards in healthcare for poor people. The political, social, economic, structural, etc. Partners in Health works to prove that healthcare for the poor [inaudible 00: 09: 21] is possible. It's closing gaps in healthcare delivery and advocating for this work.

Our mission, I think, is pretty amazing. It was written over 30 years ago, and it still remains the same today. Our founders wrote it, and when they wrote it, they really had a vision of what they'd hope to see our work do in this world. It's the same philosophy that has guided our work in [Kanash 00: 09: 50] in the 80's. It's the same principles that guide our work today. The philosophical underpinnings that have served us so well in the imagination stage, have served us well as we have grown to working in countries around the world. It had guided us through the complex and tumultuous waters of global health and equity.

It has guided our decisions as to where and how to intervene in global health crises in the world in the past, and guides our actions in decisions making now and also in the future. You all can read it, but I think what's really unique about this is, for me in particular, is this idea of providing a preferential option to the poor, that those who are poor deserve as good or even better healthcare than those who are wealthy, and I think that's really important.

And that for us is why our work is really grounded and rooted in social justice. Here is a picture of our co-founders. Jim Cam Ophelia Doll, and Paul Farmer. For the past 25 years, Partners in Health has worked to combat the diseases of the poor and the marginalized and worked to build the corresponding high quality healthcare delivery necessary to protect and advance the rights of health. Are folks aware of or ever heard of Dr. Farmer or Jim Cam? Or Ophelia Doll? You can type in the chat box if you know them.

Yes, okay great. So, some of you all know them, and just like you all, which I think is really amazing. So, I think a lot of times as young people you may think that, "How can I create change?" This picture of them here, is they were your age, and they all met when they were in college. Dr. Farmer and Ophelia back when Paul was in his first year of medical school and Ophelia was 18, she was on a gap year between high school and college, and they met in the central plateau of Haiti, and Jim Cam is now the president of the world beck.

So, think about that. They met here in Boston, Massachusetts or Cambridge right across the river, and this is our, I think what is so amazing is that their work was extraordinarily intentional. Our work is focused on those who are systematically denied access to modern medicine. Our work is built on to challenge the very structures that allows or denies that access. We strive to demonstrate time and time and again what is possible and do the political work necessary to make sure that people do have the right to health.

Just a little bit about how we started, this picture right here was taken over 30 years ago in Konge. This is what it looked like. Paul and Ophelia, like I said, met there in Konge in Haiti Central Plateau was submerged by a dam on the [inaudible 00: 12: 54].

Paula Mazilla: The Artiboinite River.

Jarrod Chin: Okay, Artiboinite River. I didn't want to mangle it, in 1956. The dam was intended to promote agro-business and to supply the capital city of [Porcrence 00: 13: 07] many hours away with electrical power. The residence of Konge all subsistence farmers received little or no compensation for their homes and wham moving up to the barren hillsides as squatters. In 1962, Partners in Health key founders was also Father Fritz and Yolan [Beaufont 00: 13: 31] established a primary school for the children of the Konge area.

Many of the students did not reach adulthood. Infectious diseases killed almost one quarter of all children. In 1983 Pam and Ophelia arrived in Konge and embedded themselves within the community. The work started with a conversation. What do the people want and need? They started surveying the community to understand what people most needed. The survey was all the unanimous. People wanted and needed access to healthcare and they wanted jobs.

So, with a network of partners they got to work. They were able to get a clinic and agricultural business project started through a community health work and network. They began a community based program to treat tuberculosis, especially drug resistant TB. That model is the backbone for how PIH conducts our work. You can still Paul and Ophelia with Jim Cam and another man by the name of Todd McCormick and one of our initial funders, Thomas J. Wight started Partners in Health back in 1987.

I think what's amazing is, you see this picture in 1984 and now I'm going to show you what Konge looks like in 2004. Obviously, it looks completely different than it did in the early 80's. Today Konge is reforested. The team has planted thousands of trees for both shade, but also to retain top soil. It contains a large socio-medical complex complete with a school, hospital, outpatient clinic, TB ward, a terminal health ward. What is even more important is that the consumption of what is considered possible for these people.

What was considered possible in global health was childish. The people of Konge and partners in health showed that it was possible to deliver high quality complex healthcare in the setting of deep deprivation and destruction. The transformation of Konge is one example of transformation that PIH has experienced during its history demonstrating what is possible in global health. We do not believe that healthcare should be reserved just for the rich.

We believe that healthcare is a human right. Healthcare should not be a luxury reserved to the wealthy. Poor people actually have very good outcomes when their illness is treated with effective treatments, and even better that treatment is linked to social problems, that the lower the social matter is that the poor face when it's access and care. United is social and this ignited a social movement for demanding access to the medicines to treat HIV and AIDS. The creation of Hepbar and the global hunt to fight AIDS, TB, and Malaria brought more money into healthcare delivery systems than have ever existed before in human history.

Those are resources that have allowed PIH to collaborate with ministries of health to build and renovate facilities and strengthen staff capabilities in health systems of countries around the world. So, our model is really simple but it is really also unique. For the last 25 years in the history of learning to deliver a community based primary care in Haiti effective in DR treatment in Peru, scaling HIV treatment in Yolanda. We have been able to learn what it takes to deliver comprehensive healthcare to the world poor, and it's not that complicated.

Essentially, every good health system has had three relatively equal components. First, it must be rooted and have a foundation community. Community health workers are crucial. They are the basis for which our entire primary healthcare delivery system is based. They are the ones that go door to door and do active case finding, provide wrap around services to those who need extra support, our bold efforts are community health worker driven to the community health workers doing case findings and community education. They're also actively hiring survivors to help encourage community members to seek out care and to recognize survival is possible.

However, those community health workers are not enough. They need to be linked to good primary care, delivery facilities staffed by nurses with sufficient medicines, equipment, and supplies to do the work of basic primary care delivery. Of course, people also get very sick and need to be admitted to hospitals. They break their femurs. They need surgery. They get cancer. Therefore, we do not believe that it is enough to stop at community based primary care. Though, that is the foundation of our work. We must also link back community based care with high quality hospital based tertiary care.

Our approach, like I said, we work in some of the poorest, most remote, most marginalized communities, and we feel they feel that it's important to offer preferential options to the poor. The poorest deserve the best care possible, and we work in some of the poorest, most remote, and most marginalized communities in the world. We tackle disease in commissions others deemed too difficult to treat. This means we're constantly questioning our assumptions about what works and what does not, pushing ourselves to be innovative.

We are often told that, that work we wish to undertake is too difficult, too complicated, or too expensive. We look to prove the naysayers wrong, and people like Annie who document our work and measure its impact and make the changes when necessary to improve the quality of our programs, and really what makes us different is this idea, or this notion of a company [inaudible 00: 18: 59]. We all kind of use it, or use the term the secret sauce in many ways, it's the defining characteristic of our work. It is our long term commitment to be there with our patients.

To hear and learn from their voices, to respect their rights, and attend to their needs. We work side by side with the communities we serve, with patients, health professionals, and public officials to provide care, build infrastructure, and manage projects. As much as we accompany others, PIH is also a company. It is a two way relationship, and I think that's extremely important that we're not just, that this isn't a charity model for us. We are accompanied by our patients and our partners, by those who support us financially and advocate on our behalf. The spirit of accompaniment counteracts the short term conditional and contractual aspects that we often come up against in global health.

When we start working, we think about the end of the relationship with the community. When the community is ready to end it, not when a contract expires. We are responding to this epidemic in the same way you are responding to the acute major of the epidemic, but we are also looking to strengthen health systems and build long term relationships with the communities we are working with. Here is a great photo of our work in Lesotho opening up a clinic, and really we're a values based organization.

These are our four values, and I want to make sure I'm being responsible of other folks time, so I'm going to kind of go through this a little bit quickly, but we believe in commitment, pragmatics, solidarity, humility, and integrity. Those are really key guides to our work, and that's how we operate at all of our sites around the world. So, we're in 10 sites around the world. It might be a little bit hard to see here, but we're in Rwanda, Sierra Leone, Navajo Nation, Haiti, Mexico, Peru, Liberia, Malawi, Wasutu, and Russia, and our team's in Boston.

I think what makes us really unique, again here, is that we're supporting all of those sites, and you all, to kind of understand what we do here is, we're doing the communications. So, we're talking with folks and we're getting our message out, clinical work, which Milenka is involved in. We're fundraising for all of this. We're managing the finances here, the Global learning training team are going out and teaching our clinicians, teaching our community health workers at our sites. Human resources is obviously managing all of our employees. You know, the medical, health insurance, payday, all that good stuff.

Medical and formatics is keeping medical records, obviously IT. So, I'm not going to go through it all, but we have three folks here who represent three of our departments. We have Milenka who is the clinical. We have Faisal who's finance, and we have Annie who receives monitoring and evaluation quality. So, really what we are trying to do is build a global health mode. We really feel like it isn't just our work itself that we want to do in providing high quality healthcare, but we folks to develop a movement as a human right that this is something that just shouldn't be in the United States or in Europe, but this is something that everybody deserves around the world.

We have some strategic priories. I am not going to get into those, but now I just really just want to turn it over to Annie, Faisal, and Milenka to tell you about their work. So, I want to slide off. So, thank you all, and if you have any questions about our work, or PIH you can [inaudible 00: 22: 54].

Paula Mazilla: Thank you, Jarrod. So, at this point we will briefly, we will transition into the panel, and thank you that's wonderful. Matt will enlarge the camera so that we have a panel type of live streaming, and I would like to just ask one question, because I think that of all the 35 students that RSVP'd this was a common question that everyone asked and that was, "What are the opportunities in global health?" And that is stubs or internships, also Masters of Public Health students have to do a practical so also talking about practical. So, I would like start with that because it seems to be at the top of everybody's priority list and anyone can answer.

Milenka J-B: I guess I will start by saying that in global health I think it's really important to account for what type of skill sets you're trying to foster, and what type of career path it is we're talking about that you want to grow into and where you might start may not be where you end up, but it's important to know the different pieces that go into forming global health interventions and programs, and in terms of job opportunities or internship opportunities that are out there, I bring this up, because I don't think they're just localized to global health organizations.

When you think about doing an internship and you're doing an internship working within an HR department that has as much applicability to global health as doing an internship working on a multi-drug-resistant Tuberculosis program for instance, and I say that because in order to run a global health non profit, you need those skill sets as well, and so I would say first and foremost that internships, which allow you to foster particular skillsets that help you to grow within an organization, such as a non-profit or even a corporation can help you in the field of global health.

That being said, I would also say that in the field of global health, many of the nonprofits, much of the work that I know that takes place within global health happens through non-profits, and many of the non-profits that I know of, and that I'm aware of are based in the east coast, but there are a growing number on the west coast as well, and so I would say, you know, there are a number that deal with working with first community based organizations that can work overseas, and send people to receive as volunteers. I think Kiva organization is an organization based out of the west coast that does type of work, but it's based off of what you guys might be interested in growing in as a field as well, public health.

I'll stop there and let anybody who wants to add, add on.

Paula Mazilla: Yeah.

Milenka J-B: Oh, go ahead.

Paula Mazilla: If anybody wants to add, that would be great.

Annie Michaelis: My answer was going to be quite similar in emphasizing the importance of hard skill. So, not just ones that Milenka sort of gave as example, but within the discipline of monitoring and evaluation I think quantitative skills, and being able to really be a whiz and excel to know a little bit about study design and statistical methods is a set of skills that is very highly prized, and I think most organizations that I know of are trying to build up their monitoring and evaluation department. So, that's something if you're interested and quantitatively inclined, that's a nice way to cement an entry into an organization where you might be offering up your skills to do some data crunching, and at the beginning it might be very basic stuff, but if you show that you can do it, you might be able to sort of grow into a more subsequent role bringing that field to the table.

Faisal Zareen: Thank you so much. I think the majority of what I wanted to say both Milenka and Annie have highlighted. Two personal things that I highly suggest to people who ask of me of any advice is, whatever you do plan it. This is probably the most important phase of your life. This is one of the most crucial decisions in your life that you will make. Not just like the feeling itself, but you [inaudible 00: 28: 05] within this field, what specific niche, or what specific exploit. What specific area are you going to target? What challenge are you going to set for yourself? What goal are going to set for yourself?

One thing that helps is to go get you best. Go get the drive that you have in yourself, that will guide you, that will give you energy. It's definitely, career today or achieving any goal today is not easy. It's not a competition, but one you go with the energy that you have in yourself, the chances are that you will find it, and you will enjoy it, and you go through it with a lot more ease compared to if you are to just pick a job that was available out there, or that this and that person and they were successful.

That's one. Second is, global health is massed. It's huge. It's needed. It was needed in the past. It's needed today, and it will be in fashion for years to come. So, you have lots of choice within the global health. As Annie mentioned, you can, as a startup focus on number, you can decide to join global health management if that works for you, or on the other side, some people are going to the technical aspects, more into programs, etc.

So, as you decide on what you want to, when you start up, consult someone who is around you, and if you have a long term plan, just see like the immediate opportunity that becomes available, do not wait until it ties up somewhere down the line with your long term plan. The opportunities are great. You can obviously work with US territories, territories abroad. There are a lot of countries that need [inaudible 00: 30: 15], but wants the projects to be successful. Once you are through with these initial stages, probably, it always makes sense to link your strengths with something else. So, I came across leads who I modeled as my mentors initially and they had one core skill that they mastered, and in the intimal they had something else.

So, someone who is an excellent epidemiologist an MD for that matter and complimented the two skills together to guide [inaudible 00: 31: 22]. Someone who was good in finance. I saw, I met a gentleman who was, he was leading a university hospital. People have come to him by training and he was talking to the doctors, to professors. He was signing off on [inaudible 00: 31: 40], and I asked him this question, "How did you do it? How do you [inaudible 00: 31: 46]? But how would you know what other techniques," and he actually learned as he was shaping up his career. So, those are some of the additional things that you can do as you speed up your success in your professional career. In [inaudible 00: 32: 11] one key thing is whatever you do [inaudible 00: 32: 16] health, global health is. When you see a patient, who you are helping, [inaudible 00: 32: 25] helping, the [inaudible 00: 32: 27] team is helping. I mean directly or indirectly, there is no exception.

And once you've see the face of someone who's [inaudible 00: 32: 40] service that you have done for him.

Milenka J-B: Alright. I think, I think I want to add to something.

Paula Mazilla: Alright.

Milenka J-B: Hello?

Paula Mazilla: Before, I just wanted to add if we can move the speaker closer, because I think that [inaudible 00: 32: 57] in and out, the audio, so I think that, that would help. I know visually maybe it's not appealing, but I think we would love to have better audio for the three of you. Thank you, I appreciate it.

Milenka J-B: Going to be farther away.

Paula Mazilla: Okay, thank you. I appreciate that. So, just to summarize for everyone, it sounds like everyone had a comment about really having strong hard skills in a particular field. Utilizing your soft skills that are transferrable from one field to another such as communication in writing skills, and then being goal oriented and doing work that comes from the heart.

So, now I know Milenka you wanted to add something, I just wanted to turn it over to you.

Milenka J-B: I was just going to mention that in the field of global health, I think one core thing that I have found that exists amongst anybody that I have encountered working in global health is that there is a need to better understand the people that you are serving, and whether you're working at the headquarters level, or whether you're working in country, the work is dependent upon understanding the core needs of the people, and I think it starts there, and I think that's something that is an interest of every single person I have met working in global health, and I think that is something that you can foster and gain, not just by working with people overseas.

But I think it's something that can also be fostered and gained by working with communities who are underserved here and understanding their needs and you can also take that into your work with global health as well.

Paula Mazilla: Great. Thank you. So, I did want to mention to everyone that the questions that I am asking are questions from our students. They submitted these during the RSVP process, and the second question that was also a number of students put on the RSVP and I that I get in my office a lot is, do we need to speak another language other than English to work in global health or at PIH:

Annie Michaelis: So, I was actually thinking about that question, which I had read on the list that you had sent us in relation to what Milenka was just saying. So, it's not absolutely required, but it's incredibly helpful, especially for that important task of really understanding and connecting with the people that you're trying to serve. So, it's something where after coming to Partners in Health, I've worked hard to learn Haitian Creole, and it was a language I didn't speak before I came here, but my relationships have been able to deepen so much with providers and the staff members at Zambe La Sante, our sister organization, and I just get a lot more out of my trips, and I also am able to give more by being able to speak the language.

Even only basically, I am not fluent yet, but being able to at least understand some of what's being said to me and being able to communicate on a basic level, and then with the goal of increasing over time, and I think also people see that you're making that effort to learn their language, and they realize that you're really putting in your effort to serve them, and to meet them halfway rather than assuming that everyone else is going to learn English. So, I think it's an incredibly valuable skill to have.

Faisal Zareen: Yes, and in addition to language, the other most important thing, especially when you are in the period is cultural understanding, culture respect, social awareness, not every country is the same. Communities, once you make an effort to learn everything, then to demonstrate that you made an effort to go through their culture, their social aspects of life, and you are happy to demonstrate them as best as you can, while within their community, they take it as a sign of respect, and then they start returning to you, what you are giving them.

So, the more you do that, the better it is for you to become better connected with the communities.

Milenka J-B: Yeah, I want to echo a lot of what was just said. I think it's ... depending on the type of work you would be doing, it may or may not be essential, but it definitely is a bonus to do so for many of the reasons that were just stated, for being able to show respect, ability to work with people, and to show that the bi-directional nature of the relationship. So, I think it's something that it is beneficial for wherever you wind up working.

Paula Mazilla: Thank you, so much. Well, I would like to now switch to the question, which is, what are the biggest challenges in providing quality of care to the poor, and what is PIH currently doing to address it?

Annie Michaelis: That's a big question.

Milenka J-B: Yeah.

Annie Michaelis: It's like there are many places to start. I think there is always a scarcity of resources, and so making the decision about how far do we push our very thin resources to be able to reach every person that needs reaching and with every possible condition that they might have, and I think it's one of the awesome things about Partners in Health that we're not willing to just sit and not treat a person with cancer, because they happen to live in a country that's impoverished and that doesn't have an existing cancer program, but I think that, that also does make our work a lot harder.

Because when we branch out to treat more, and more, and more complicated disease areas, we're spreading the resources more thin, and so that ongoing challenge is how do we use the resources that we have as efficiently as possible to climb this mountain higher and higher. There is always more.

Milenka J-B: There's another level.

Annie Michaelis: Yeah.

Milenka J-B: I think in addition to that, you know, one of the things that makes Partners in Health very unique is that it tries to address health through the lens trying to address social determines of health or social forces that impact health like poverty, like racism, like classism, and a lot of these issues don't really have any. Like there is no pill that cures these things. So, it's kind of like, we're trying to address these issues in the vein, at the same time that we're trying to provide medical access to healthcare as well.

So, that makes it difficult, too. That extra added layer, but it's something that we need to do to address the healthcare issues that people are facing. So, I think that makes it a little bit difficult, but I also think it's rewarding when we do have achievements in that as well.

Faisal Zareen: Nice, and I believe [inaudible 00: 40: 41], and may have said in linking into it with the specific stage of field care we have at the moment, resources are scarce, the need is great. What can we do? We, especially like the health management or service delivery personnel, we do not have a lot money for long term invest, but where we can help is we can make the best use of the resources that we have at our hands. Whether it is service delivery itself, or whether it is health management, in both of these areas the appropriateness of the design our programs, the efficiency in which those programs are delivered, and then having [inaudible 00: 41: 36] space, and [inaudible 00: 41: 38] results of to understand how fast our programs are performing and to feed into the feature policy program and design.

These are some of the major areas in which the services of health management personnel like us become a living element, and I'm sure some of you would be thinking on having your careers on the same lines, and if so you should keep focusing on these areas, but chances are the donors who are giving us money are donors, governments, etc. we may make the best out of whatever resources they will give us to maximum possible benefit to the beneficiaries and then to contribute to our system.

Paula Mazilla: Thank you, so much. Just to recap, it seems like some of the barriers of that scarcity of resources just like here and abroad, we have social determinants such as race, and class, and here we classify class as zip code. That's where you live and your zip code kind of classifies you and how long you will live, and then that it sounds like you really do try to make the best use of whatever resources you have to implement it into this vast need. So, just to transition on these resources, there is a question on resources. What are the strategies that PIH used expand and obtain the needed care in resource constraint areas?

So, if we can expand a little bit, I know we touched on it, but maybe expand a little bit more? That would be great. Thank you.

Annie Michaelis: I mean, I think one of our major areas that we're trying to build on Partners in Health is to build out our information systems so that we have better and better information in order to share with current donors and potential donors, because that's going to be the most important thing. Well, I'm biased. I really lie data, but one of the most important things is that we find some way, whether it's qualitative or quantitative to communicate to the people who have resources what we're doing so that they're inspired to share those resources and help us push forward all the work that we're doing.

Whether that's through a public sector grant through a government, or whether it's through pulling on the heartstrings of individuals all around the world by sharing some of the stories of the work that we're doing. So, one thing that my team and our sister teams in MAQ around the world are trying to do, is make sure that we're getting more and more information about the results of the healthcare that we're delivering, and that's something that's surprisingly hard to do.

If you imagine the US healthcare system, even here we don't have as good information a we would like about healthcare delivery and about health outcomes, but in the countries where Partners in Health works, we're typically working in Ministry of Health systems that are pretty much entirely paper based and trying to collate information from just stacks upon stacks of paper registers and forms, and be able to bring that information all the up to the headquarters offices where we can make some sense out of it, and then follow the information back down to the clinicians that are doing the care to try and give a sense of what's working and what's not working.

It's something that we, I remember seeing on the list of questions, there was a question about do we have electronic medical records, and so far Partners in Health has EMRs for all of our HIV patients in the sites that we have been in for a while. We don't yet have them in Liberia and Sierra Leone, because we only just started there, and we have ambitions to have EMRs for general patient care across all of the different disease areas, but we're sort of slowly building from there.

So, in addition to our HIV EMRs we're starting to build primary care EMRs in Haiti, which sort of allows us to register any patient that's coming through the door and understand at least a few basic pieces of information about them, and then over time we would like to move closer and closer to a fully electronic paperless point of care system where it's actually a doctor or a nurse sitting with a patient and also typing onto the computer, or onto a cell phone or a tablet what's happening with that patient.

That's the vision for the future, and right now we're sort of laying the early stepping stones towards that vision.

Faisal Zareen: From a resource constrained perspective, in addition to whatever PIH has achieved so far, the community based modern of service delivery we linked the accompaniment of professional treatment, which actually shared that program designs for some of the large [inaudible 00: 47: 16] donator around the world, and not only is PIH delivering those programs, but there are others who are acting on footsteps of PIH and doing the same thing elsewhere. I see has three important things that they bring to the pool and [inaudible 00: 47: 38]. First is of course service delivery. We have a huge network of people on the ground. Nurses, doctors, etc., who are supported by clinics here in Boston and then our partner organizations have specialized employees who are important extra service delivery on the ground.

That's one way that [inaudible 00: 48: 06] is doing a tremendous amount of work. Whether it's Ebola, whether it's [inaudible 00: 48: 07], whether it's TB, you name it, the PIH has been contributing for a long period of time, ever since its inception. Second is obviously they bring money to the poor communities, and so it seeps money from donors. We receive a [inaudible 00: 48: 31] from our government and we receive donations through our own resources, but we also receiving [inaudible 00: 48: 42] for that natter and in, and these resources matter to communities and governments who need help.

Then the third important thing, which I think plays a very important role in sustainability, and it's probably is very crucial in the long run towards helping the resource gap that we've got and its capacity. The local communities, their needs are great. [inaudible 00: 49: 19] that do not have a lot of [inaudible 00: 49: 21], especially in the countries where we're working. The list goes on. We could keep on injecting money, we don't work on the capacity building of those communities, and government, and other [inaudible 00: 49: 34], especially local organizations. The chances are that we would need to print them forever, on the other side training them or leading them to more key practices of service [inaudible 00: 49: 49], could put them on their own feet.

They could share this strategy. They could input into the country, and ask their governments to advocate more funds towards the human resources development on that country, thereby reducing the lines on international funding. This needs to be, I think, in order to understand how PIH is going to [inaudible 00: 50: 19] to our resource gap, these are three ways in which I classify PIH work. Of course there is tons of [inaudible 00: 50: 31], and obviously we can research it online as well.

Paula Mazilla: Thank you so much. So, we have about nine minutes left. I'm very excited. All the information that's being dissipated to our students, and I do want to get into some of the topics that some of our students are interested, and our students talked about learning more about the HIV work that PIH is doing, some maternal and child help, or some tobacco control if anyone can talk about a specific project and maybe some outcomes, some early outcomes that you have so far, that would be fantastic. Thank you.

Annie Michaelis: So, one thing that occurs to me is, maybe just a profile. The HIV work that our team in Malawi is doing, because I think that they have a really interesting model. So, they've actually in the past few years changed their model of HIV care from being more of a vertical program like most countries have at this point, where they either just focus on HIV, to being what they call their integrated chronic care clinic, or we internally called it the ice cubed clinic. Like IC Cubed, anyway, the IC Cube clinic in Malawi is awesome, because it is basically leveraging resources that are available for HIV to treat not only HIV, but all the other things that patients come in with.

Because they were realizing that because foreign governments are very keen to give money for HIV and often less keen to give money for things like heart disease or other issues that both people with HIV and people without HIV have, and so basically they realized that they have a lot of robust staffing models and tools for providing good chronic care for HIV patients, that are essentially transferrable to any kind of chronic disease.

Regardless of what disease you have, you have to come into the clinic at a certain frequency, get your medications, get your check in with the doctor, and then go back to the community. You need the same sort of community health worker support at your home for medication adherence, for the same kind of social programs for helping you if you're too poor to buy food, and so the integrated chronic care clinic is really using that HIV model for any patient with their chronic condition regardless of whether it's a communicable disease like HIV or TB or a chronic one of other varieties, and they've had some really exciting results.

They're working on a paper right now that profiles within that how their outcomes are looking on HIV in particular, because of the worries when they started that program was that by branching out and using resources not only for HIV but for all these other conditions, they might dilute the effect and have not as good effects on their HIV patients. But it turns out that in Malawi, and I won't give away the results of the paper, because it's not quite published yet.

But in rough terms, they are essentially spending, I think about $80-90 more per patient over the course of a year than the national level of expenditures, which is still literally thousands of dollars less than we spend on HIV care for a patient for a year in the US. So, it's not a large amount of money. So, they are spending more, but in spending that much more, they are also achieving much, much better results in terms of long term patient survival and retention in care, and so the paper that's going to be coming out is talking about sort of the impact of that, both in terms of costs and potential sustainability, and what the impact is in our little district, but also if it the model were to be scaled up in Malawi in general.

So, that's a good example of an innovative clinical care model and how we're trying to work with them to measure the success in a way that can communicate the results to the global community, not only for PIH fundraising, but also for if it's a model that works, maybe more people around the world could use it.

Milenka J-B: Similarly, I think across all PIH sites for HIV programming, we're working towards implementing programs which are in line with what the World Health Organization 90/90/90 model, which basically speaks to 90% of the people living with HIV in the community being identified, 90% of those people being treated on anti-retro-viral, and then 90% of those people being virally suppressed, and throughout all of the sites in which we work and have HIV programs, most of our sites are trying to implement this, and also trying to implement this in a very PIH way, which means we're also providing a lot of social support for people so that they're not left alone in doing this, and that they're also getting food packages, for instance, to be able to take their HIV Medications.

Or being able to have a community health worker accompany them to their visits when needed. We are trying to better strengthen our monitoring and evaluation around this. So, as we do this, we'll be able to better track our progress towards the 90's, but we're trying to align ourselves with that model in general as well.

Paula Mazilla: Okay. Thank you so much. That sounds like an amazing innovative project that you have around integration clinic conditions into the care of HIV. One of the things that I do want to touch upon before we get off, is that I'm excited that we had a meeting with our students that are interested in doing global work that happened on Friday at 11: 00 in the morning, and then subsequently the administration had the immigration executive border, and I had a few students RSVP that very next weekend and say, "What are the impacts? What's the impact of PIH's work with this new executive order, and can anyone talk about that?"

Annie Michaelis: And we do have colleagues around the world, one of my team members, our senior manager is a green card holder, and we had to scramble at the last minute because Kiva is about to embark on a trip to Sierra Leone and he said, "I think I feel comfortable doing this." He's not from one of the seven countries, but he's from Rwanda, and he was pretty worried, just personally, is something going to change in the next couple weeks while I'm away in Sierra Leone supporting my colleagues there where they won't let me come back to my family?

So, I feel like that's just a very personal example on my little team of how this is impacting us. He did decide to go to Sierra Leone and we feel hopeful that nothing is going to happen, but it's there's so much. I don't think anybody really knows what's going to happen. I know that PIH has taken an organizational stance very strongly against the executive order. This is crazy. It affects our work around the world, and yeah, but I think we're all just holding our breaths, and hoping that the court system can put some good checks on what the administration is doing right now.

Paula Mazilla: Okay. We also found out with the Washington Post that the administration said that there might be a UN decrease in $40 million I think, if I remember correctly. Is that something that will impact the funding for PIH?

Faisal Zareen: We have yet to receive UN funding, however UN funding, the way Unite works is they work very closely with the governments of the country, and whether the funding gets cut out for PIH from UN side or it gets cut out from the governments of the countries in which UN operates, the implications of this are grave for obviously for the communities. A certain cut, especially a big cut for an organization like UN, which not only is not good for the UN, but it has impacts for the international organizations like [inaudible 00: 59: 22].

There are so many that receive funding who are dependent upon the United Nations programs. So, obviously, you know, cutting funding can be [inaudible 00: 59: 34] with [inaudible 00: 59: 40] HIV there are millions of patients, TB. There is so much need. Cutting funding will not probably achieve good for other people in other countries.

Annie Michaelis: I think one important thing for all of us who are working hard in the field of public health to be able to explain to our families and our friends, and people in our broader communities is just what a tiny amount of what the US budget goes towards international aid. I think there have been surveys done that show if you do a poll of American citizens they think it's something like, "Oh, 25% of the GDP goes towards helping other countries." It's less than 1%, and so it's really important to put that into perspective, especially with all the debates about, "Oh, we're going to fix our deficit problems, and we're going to spend more money on the US rather than on these foreign countries."

All that rederick is really silly when you're talking about something that's a very small portion of the budget, and I would argue should be a much bigger portion of the budget, but I think that's an important fact that you can bring if you're having debates with people what the polices are and whether it makes any sense to cut off funding for international aid.

Paula Mazilla: Thank you so much. We have reached our time here. I enjoyed listening about your innovative systems that you have implemented, your efforts to deliver health and work on models of sustainability, and you know it's heart breaking to hear about how scarce the resources and where we're going with the current administration, and I just wanted to say thank you so much to the students for participating today. I also want to thank our panelists for giving your time.

It is very important for our students to hear from the experts that are in the field and it's an invaluable resource that you offered today, and special thanks for Jarrod for recruiting all of the PIH panelists, Matt for his technical support, and I do want to mention that the takeaway message for all our students is to start your career development early. Start thinking about your goals like Faisal said. Think about your hard skills and really becoming an expert, such as a data analysis or quality improvement, and what Milenka mentioned about the skills that you can learn at home in the non-profit or during an internship, there are soft skills that they can be transferred into the Global Work.

So, I just wanted to say thank you, and just say I was very impressed with all the work that you're doing.

Annie Michaelis: Thank you.

Milenka J-B: Thank you very much.

Faisal Zareen: Thank you so much.

Paula Mazilla: If anybody is available and wants to ask a question to the panel, we only scheduled you for 1: 00 PM. Matt, can you stop recording please? But the students who are still on the line and would like to ask a question of our panelists, this will be an open mic now.

Milenka J-B: At our Russia program where there is relatively good access to internet and phone connections compared to a lot of our sites where we have really, really limited connectivity, but in Russia they are just now piloting a program where for some of the TB patients who are receiving daily directly observed therapy instead of doing that using Skype video chat as a way to connect them, and it would be a more resource sufficient way for the program to support a larger number of patients, especially in the winter, when we basically work up in Siberia where the roads get pretty impassable and it's difficult to reach all the patients during some parts of the year.

So, if it works, if the direct leads of therapy over video works well ,then that would be something that we might consider adopting more broadly. I know that's not exactly your question, because it's not fully a consult over video, but that is sort of the closest thing that I'm aware of, and then the other thing that is sort of in that vein is that we do get support from specialists in the US that some of the hospitals here in Boston in reading radiography from Haiti and sometimes consulting with us about various cancer biopsies and that sort thing.

So, we're definitely using remote support of medical professionals in the course of our daily work.

Faisal Zareen: And this tele-medicine is really a really huge scope exists for future development, and if this is something you are interested in then probably you can do a lot of it right here. A lot of countries, they of course need internet is one of the key things that when resource [inaudible 01: 05: 01], that they have poor countries have got a limited, but also making available time on the other end. [inaudible 01: 05: 12], and support either in service delivery or medical [inaudible 01: 05: 16]. The need is vast, believe it or not.

Milenka J-B: I think over time-

Paula Mazilla: Thank you very much.

Milenka J-B: That kind of connectivity is only going to get better, even at our very remote sites, and it is getting better over time, and I think that there are big international indoshops try to make that happen faster.

Paula Mazilla: Are you involving as they said, maybe academic institutions in partnering to maybe provide that type of service?

Milenka J-B: Yep. We have partnerships through Harvard medical school and the Brigham, and there are probably others that I don't know about as well.

Paula Mazilla: Okay. Great. Well, I think that's our last participant.