Patrick Lee, MD, is the founding director of the Global Primary Care Program at Massachusetts General Hospital. The Department of Medicine initiative seeks to train future primary care leaders to advance the cause of health equity and strengthen health systems in the United States and around the world.
“Global lessons for local solutions.” That’s the motto of the Global Primary Care Program at Massachusetts General Hospital. We can use examples of best practice from around the world to build better health systems and improve primary care right at home — wherever home might be.
The Global Primary Care Program partners with two clinics: one in Chelsea, Mass., and the other in Bugoye, Uganda. The patients I see in Chelsea come from all over the world. Many are poor, suffer from chronic medical problems and have a hard time navigating the health system. Many fall through the cracks. They show up later on with serious diseases that are much more difficult and costly to care for. This is an entirely preventable problem. Yet it happens every day in cities across the U.S. and around the world.
One of the best ways to care for these patients is to pair them with a community health worker who can help them navigate the system and keep up with their medical care.
The Global Primary Care Program was founded to teach tomorrow’s healthcare leaders how to translate global lessons into local solutions.
Filling the Gaps in a Fractured System
These community workers are part of the health team and part of the community. They fill in the gaps in an otherwise fractured system. Pilot programs at MGH and across the U.S. are using this strategy to improve care and lower costs for their most expensive patients. Someday, a community health worker may accompany all of us through our toughest stretches of illness.
Ironically, the idea of using community health workers comes from places like Bugoye, Uganda. There aren’t enough health professionals in Uganda, so every community elects several members to serve as village health workers. These health workers have traditionally been limited to teaching good hygiene, carrying out vaccination campaigns and assisting with other public health activities. But malaria rates have skyrocketed recently in Bugoye. Last year, half of all the children with malaria came from five villages upstream from a new hydroelectric dam.
Others may have profited from the dam, but it is the poor villagers in Bugoye who have to live with the surge in mosquitoes and malaria. To help stem the tide, we are partnering with a team in Bugoye to teach village health workers how to safely diagnose and treat children with malaria. In doing this, we are piloting a new Ugandan national strategy for preventing childhood deaths. Interestingly, training community members to do work usually reserved for health professionals issomething we cannot yet do in Chelsea, even though it might be a safe and effective way to help catch illness early, when it can be easily treated. Could this be the next frontier of global lessons improving primary care at home?
The Global Primary Care Program was founded to teach tomorrow’s healthcare leaders how to translate global lessons into local solutions. In 2011, we launched a new residency track that enhances clinical training at MGH with both classroom and real world experience in putting comparative lessons to work at home. Residents complete a master’s degree at the Harvard School of Public Health, care for patients in their primary clinic in Chelsea, and spend eight months over four years helping to improve care in Bugoye, Uganda. They are challenged to write a thesis addressing crossover issues between these two settings. We believe this grounding in the theory and practice of innovating across settings is unique among U.S. residency programs. We also know it is in high demand. This year, the Global Primary Care Residency received more than 600 applications from 86 countries and 33 states for two positions, making it one of the most competitive residency programs in the country.
Global Primary Care Scholars will renew their commitments to service while enhancing primary care teaching at Mbarara University, MGH’s academic partner in Uganda.
Creating Opportunities in Global Primary Care
Building on the success of the residency track, we are working to extend the benefits of a “global lessons for local solutions” approach to MGH’s front-line health professionals. The Global Primary Care Scholars Program, launched in early 2012, will enable teams of doctors, nurses and administrators from four MGH primary care practices to make a two-week visit to Uganda. Global Primary Care Scholars will renew their commitments to service while enhancing primary care teaching at Mbarara University, MGH’s academic partner in Uganda. They will look for lessons learned in Uganda that can improve primary care in Boston. They will share their findings with the MGH community on their return. If all goes well, this new pathway for MGH teams to teach and learn alongside their Ugandan colleagues may help build excitement for primary care careers on both sides of the partnership.
In today’s interdependent world, it’s vital that we learn from one another. The Global Primary Care Program creates opportunities for MGH and Ugandan primary care trainees and faculty to serve and learn together. Building on MGH’s 200-year commitment to excellence and the care of diverse communities, the Global Primary Care Program is developing leaders able to translate global lessons into local solutions to improve primary care in the U.S. and around the world.
To learn about more ways to support the Global Primary Care Program at Massachusetts General Hospital, please contact us