Bending the Arc of Justice: The Division of Global Health Equity Celebrates its 10th Anniversary
The BWH Division of Global Health Equity celebrates its 10th anniversary. From left, Jim Yong Kim, MD, PhD, Howard Hiatt, MD, Don Berwick, MD, MPP, Mark Rosenberg, MD, and Paul Farmer, MD, PhD, gather.
Paul Farmer, MD, PhD, remembers the first time he heard the term "AMC" when he was a new medical student at Harvard in 1983. He assumed the reference was to the movie theater chain. For Farmer, however, "AMC" became what he called an "area of moral clarity"-the basic need, moral obligation really, to treat the sick and destitute people so desperately in need of care in Haiti.
"‘AMC,' I came to learn, also means academic medical center," said Farmer, chief of BWH's Division of Global Health Equity. "I wondered what on earth an academic medical center had to do with the problems of the destitute sick, even in our own country-much less places like Haiti, Rwanda, Malawi or Lesotho. And the answer back then was: not nearly enough."
But in the coming years, a group of forward-thinking physicians and hospital leaders would change the status quo, creating the Division of Global Health Equity (DGHE) as a formal academic home for global health at BWH. In the decade since it was launched, DGHE has made remarkable progress in patient care, research, and education in underserved communities around the globe and close to home.
Global health luminaries joining Farmer in celebration of the division's 10th anniversary last month included Jim Yong Kim, MD, PhD, president of the World Bank; Donald Berwick, MD, MPP, former administrator for the Centers for Medicare & Medicaid Services; Ophelia Dahl, executive director of Partners in Health; and BWH President Betsy Nabel, MD.
The guest of honor at the event was Howard Hiatt, MD, an early mentor of Farmer and Kim, original deputy chief of DGHE, and current associate chief of DGHE. "When Paul and Jim decided to focus their attention initially on Haiti, and shortly afterwards on the problem of drug-resistant tuberculosis in Peru, and asked whether I would be willing to work with them, it was really a privilege I found impossible to turn down," Hiatt recounted.
Drawing not just from medicine but also a variety of other disciplines such as anthropology, public health and sociology, this early work of Hiatt, Farmer and Kim prospered and began to draw attention for its stellar outcomes treating TB and HIV in developing countries.
Alumni from the DGHE Residency Program
work across the globe in clinical and
In recognition of the new discipline taking shape, the Division of Global Health Equity was formally established at the Brigham as part of the Department of Medicine, existing alongside longstanding disciplines like cardiology and endocrinology.
"The division ushered in a shift in how academic hospitals view global health, and the responsibilities hospitals have to the global community," said Sonya Shin, MD, MPH, a faculty member since the division's inception.
The division also established a training program for the next generation of global health physicians. "It soon became apparent that this need and desire to improve global health was an attractive career path for a substantial number of young doctors," Hiatt said. "So early in 2004, we put together a training program. Not only was there now a new area for inquiry, but an area for inquiry that was attracting some of the most amazing people I've ever known."
The Doris and Howard Hiatt Residency in Global Health Equity would become the heart of DGHE, preparing young leaders for the still emerging field of global health. The residency program accepts four to six physicians a year, and allows them to do longitudinal work during field rotations at BWH and Partners In Health affiliated locations throughout the world, while completing their residency in internal medicine and also earning a Master in Public Health degree.
"I could not be doing the work I am as a fellow without the experience I had as a resident," said Natasha Archer, MD, MPH, who recently completed the Hiatt residency and is currently a hematology/oncology fellow at Boston Children's Hospital.
Archer is drawing heavily from her experiences as a resident in Haiti as she begins her next challenge - setting up a sickle cell disease program there.
"Without having the knowledge and relationships, or a sense of the structure that's already in place, it would have been virtually impossible to propose that project for my fellowship and do that work," she said. "Howard Hiatt has been a tremendous mentor. He is a constant champion for the underserved and reminds us that whatever we're doing, there's still more to be done."
Hiatt's influence at DGHE extends beyond his work improving global health. Frequently mentioned during last month's celebration were Hiatt's decades of contacts and knack for connecting people professionally, just when they needed some guidance.
Hiatt passed on a sense of possibility, and also responsibility to make the world more just and fair, to his many mentees. "Through mentoring so many of us, he has bent the arc of history towards justice," Kim said.
For DGHE staff, making the world more just has taken a variety of forms: improving community-based health care in Rwanda, increasing support for people with diabetes in the Navajo Nation, training community health workers to work with people living with HIV/AIDS in Boston, and constructing a national teaching hospital in Haiti, to name just a few.
In turn, some of DGHE's work has influenced practices at the Brigham. For example, Farmer cited the notion that chronic disease care should reach "into people's homes and everyday lives. That's something we were forced to do in Haiti, Rwanda, Malawi, Lesotho in the ‘80s and ‘90s," and now occurs at BWH through initiatives such as the integrated Care Management Program.
While DGHE's work eliminating health disparities across the globe is far from complete, it has jumpstarted the movement among academic medical centers to become involved in global health. By serving as a model to other teaching hospitals, DGHE may inspire enough people, capital, and political will to reshape the world's health.
Howard Hiatt has been a driving force for eliminating health disparities