4/27/2011. Kim Wilson, MD MPH Boston Children s Hospital
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1 Providing Care to Dominican Transnational Families Is Global Health Linked to Local Public Health? Kim Wilson, MD MPH Boston Children s Hospital Overview Providing care to Dominican transnational families in Boston Infante Sano: Maternal Infant Initiative in the Dominican Republic How does global health work effect the care you provide in the US? Opportunities for involvement in global health. 1
2 Primary Care for Dominican Families Martha Eliot Health Center Health Center, Bani Immigrant vs. Transnational 750, 000 Dominicans in US; 56,000 in MA Frequent travel and circular migration Maintain social, economic, health and support networks in both communities Family separation, reunification, role of extended families 2
3 Transnationalism and Challenges to Health Disruption/duplication of care Access to medication and alternative therapies Cultural beliefs and practices impacting health Role of transnational family in medical decision making Differing expectations from health providers Pilot Work Multidisciplinary teams from CHB Building partnerships with Pediatric Staff at Bani Hospital Needs assessment Training PALS, NRP, pediatric asthma, HIV Resident and medical student clinical experiences 3
4 Paradox of Maternal Neonatal Health in the Dominican Republic Maternal and neonatal outcomes 100 strongly linked to access to skilled care at birth 80 > 98 % of mothers receive antenatal care and deliver in hospitals Maternal and neonatal mortality remain high Dominican Republic Chile Costa RicaGuatemala Bolivia Haiti Skilled Attendant at Delivery Antenatal Care Coverage Issue is quality of care, not access to care Over medicalization with C/S rate > 40 % Infante Sano non profit formed to with a mission to improve the quality of maternal and newborn health care by: Training physicians, nurses, and community health workers Equipment and facility upgrades Data based multidisciplinary quality improvement programs 4
5 Where we were working? 3 Regional Hospital Sites 10,000 deliveries/year Established 2 community clinics Newborn Resuscitation Program Delayed or no resuscitation due to lack of skilled staff and necessary equipment Training program for nurses in basic NRP (TOT) Equipment/resource needs Instructors trained 150 nurses and doctors in the region. 5
6 Improving Maternal Care: Use of the Partogram Training in use of the partogram/obstetric care Protocol for monitoring labor to identify emergency obstetric complications and reduce fetal complications Vital sign training for nurses From 0 to 60 % use 6 months Hospital systems improvement Renovations to facility, electrical system, medical records system Provided suites of equipment for maternal/newborn areas Formed quality Improvement teams Designated nursing staffing for maternity and special care nursery 6
7 Community Health Opened 2 Maternal child primary care clinics Community health promoters and health committees I CATCH Grant: Newborn Home visiting program Aerosmith Grant: Prevention of Vertical Transmission of HIV Babies Matrix Age at death (infant) g Intrapartum Predischarge Antepartum Postdischarge Pre pregnancy health Tool for identifying opportunity gap for intervention g g Care during Pregnancy Care during delivery Newborn maternal postpartum care Infant Care Counts of perinatal deaths by time period and birth weight. CDC 7
8 Using data to prioritize interventions: Use of the Partograph 8
9 Results: Bani Can Global l Health lh Work help you in Boston From Primary Care to Public Health Programs What we can Learn From Each other. 9
10 Different Settings, Same Health Concerns? DR MOH Priorities Injury prevention Maternal Child Health Mental Illness Obesity and primary prevention of NCD Adolescent pregnancy Substance abuse Child Health Priorities in Boston Obesity Mental Health Injury Environmental Health Adolescent pregnancy Substance abuse Clinical care Experience in infectious disease: TB, cholera, measles, polio, antibiotic resistance Travel Counseling Management of chronic disease in transnational patients. Cultural context for health care Patient expectation of health encounter Ethnic Tensions 10
11 Program Development Context for public health programs and messages Supporting strengths of cross cultural lifestyle Global Health approaches that work: Community based health workers and committees Leapfrog technologies mhealth Center for Global Health at Children s Hospital Boston Partnerships with global sites/ngo s to help build local capacity in pediatric care PIH Rwanda/Haiti Liberia and HEARTT Global Pediatric Fellowships Education: Conferences, Seminars, list serve serve Research 11
12 Thank You 12
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