2020 Cohort of HGHI Burke Global Health Fellows

Adeline Boatin, MD, MPH, is a clinician, researcher and educator at Harvard Medical School and Massachusetts General Hospital in Boston, USA. She received her undergraduate education at Harvard University and her medical degree at the College of Physicians and Surgeons University. She completed an MPH with a focus on international health at the Harvard School of Public Health and then completed a four-year residency in Obstetrics and Gynecology at Harvard.  She is currently an Assistant Professor in Obstetrics, Gynecology and Reproductive Biology at Harvard Medical School. She is affiliate faculty at the Center for Global Health at MGH and the Program for Global Surgery and Social Change at Harvard Medical School and the.  In addition to clinical care and resident training at MGH, she is an NIH-funded clinical researcher with a focus on reducing global reproductive health inequities, particularly around the provision of safe and quality surgery. Her current research focuses on using wireless monitoring technology to overcome human resource limitations in post-operative care and the spectrum of quality of care around obstetric surgery in low and middle-income countries.

Project Title: The Cesarean Delivery Triple Burden: Examining Underuse, Overuse, and Quality of Cesarean Delivery in Uganda

Project Description: Access to a safe, timely, and medically indicated cesarean delivery is a critical component of safe motherhood. And yet, in sub-Saharan Africa, where maternal mortality is the highest globally, there is an emerging triple burden associated with cesarean delivery: morbidity and mortality associated with a lack of access to cesarean delivery, morbidity and mortality associated with the unsafe provision of cesareans, and a growing proportion of unnecessary cesarean deliveries that may waste already limited resources and put women at risk unnecessarily. This triple burden has been masked by low population-based national cesarean delivery rates. Thus, unsafe cesareans and unnecessary cesareans in sub-Saharan Africa are under research. With support from the Burke fellowship, I will conduct research to develop our understanding of the unfolding burden associated with cesarean delivery in sub-Saharan Africa. Specifically, I aim to explore variation in cesarean delivery rates and outcomes across regional referral hospitals in Uganda, where despite being at the same level of care, cesarean delivery rates vary from 12% to over 50%, and associated outcomes have not yet been examined. I will explore clinical and system factors associated with the varying cesarean delivery rates across institutions and determine the associated outcomes. I will also use qualitative methods to understand how the multifactorial interplay between users of the health system may interact to drive variation in cesarean delivery rates and outcomes across institutions of the same cadre nationally. This research will provide the platform to identify strategies to optimize access to cesarean delivery, improve safety and reduce unnecessary use of the procedure.

Matthew Bonds is an assistant professor in the Department of Global Health and Social Medicine at Harvard Medical School, and co-founder & scientific director of PIVOT. He holds a PhD in economics and a PhD in (disease) ecology from the University of Georgia. His research focuses on 1) the ecology of poverty and economic development; 2) infectious disease modeling, and 3) global health implementation science. PIVOT works with the Madagascar government to establish a district-level model health system. With novel data systems at all levels of care (community, primary and secondary care) combined with a population-based longitudinal cohort study, this partnership aims to pioneer a new science of health system transformation. His work has been supported by a K01 Award from the NIH Fogarty International Center, a Scholar Award in Complex Systems Science from the James S. McDonnell Foundation, and a Rainer Arnhold Fellowship from the Mulago Foundation.

Project Title: Research training in rural Madagascar

Project Description: The Burke Global Health Fellowship will be used to launch a training series in research methods and dissemination for health professionals in Madagascar. The participants will include clinicians as well as specialists in monitoring, evaluation, and research. The aim of the training is threefold:  1) to build long term research capacity for practitioners; 2) to support a culture of curiosity in health care implementation;  and 3) solve important questions immediately relevant to care delivery and policy.  The series includes three week-long workshops in which participants (at least one medical professional and one data professional) will collaborate in small teams on a hands-on research project from start to finish. The series will take the students from protocol development to data analysis and interpretation through to writing and dissemination. Between sessions, students will make guided progress on their projects with support from their faculty mentor. The final product will be a manuscript or report written in English. It is expected that following the training, students will be able to actively participate in and lead research projects. The course instructors will be researchers already engaged with PIVOT, including faculty from Harvard Medical School and Institut de Recherche pour le Développement. Research projects will rely primarily on existing data from the Ministry of Public Health and PIVOT. Lessons from this first year-long series will inform future iterations of the course.

Dr. Dhruv Kazi is the Associate Director of the Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology and Director of Cardiac Critical Care at Beth Israel Deaconess Medical Center. He is a member of the faculty of medicine at Harvard Medical School, and an affiliate faculty member of Harvard University’s Global Health Institute. Dr. Kazi is a practicing cardiologist, health economist, and outcomes researcher who uses real-world data to examine the long-term consequences of clinical and policy interventions on the cardiovascular health of the population. A particular focus of his work is the identification of cost-effective and scalable interventions to improve the cardiovascular health of vulnerable populations in the US and overseas. His work has been influential in determining the price and uptake of novel therapies, increasing access to cost-effective innovations in healthcare delivery, and reducing the use of low-value interventions. Dr. Kazi completed his medical training at the University of Mumbai, clinical training at Baylor College of Medicine and the University of California San Diego, and his research training at the London School of Economics and Stanford University.

Project Title: Double Jeopardy: Climate Change and Cardiovascular Disease in Urban India

Project Description: India’s economic growth has fueled rapid urbanization and changing lifestyles, resulting in large increases in the prevalence of diabetes, hypertension, and obesity. As a result, cardiovascular disease is now the country’s leading cause of death, and a major cause of disability. Over the coming years, climate change is likely to compound the health and economic effects of cardiovascular disease in India in several ways: worsening air pollution and rising temperatures may increase cardiovascular risk, extreme weather events and sea level rise may undermine existing health infrastructure and supply chains, declining agricultural productivity may compromise food chains and nutritional quality, and climate-related migration may adversely affect both the demand for care and the supply of skilled labor to deliver it.  Quantifying the complex effects of climate change on CVD burden and outcomes is critical to advocating for mitigation and planning for adaptation, but this has not been systematically done. In this study, we will project the long-term effect of climate change on cardiovascular health in Mumbai, India – a large, densely populated metropolis of 18 million people that sits almost entirely on land reclaimed from the sea and has been identified by the World Bank as being at very high risk from climate change. to project the most likely trajectory of climate factors and their outcomes. Our simulation model will synthesize the best-available clinical, epidemiologic, cost, and demographic data for Mumbai in order to evaluate the effect of climate change on the population burden of acute myocardial infarction and associated outcomes in adult Mumbaikars between the years 2020 and 2040. Our results will help inform planning and advocacy for climate change mitigation and health system adaptation in Mumbai. Results of scenario analyses will help quantify the cost of inaction, and, in the case of the optimistic scenario, illustrate the potential benefits of timely action. Because of Mumbai’s size and location, its experience with climate change will hold important lessons for other large cities like Dhaka, Shanghai, and Hong Kong. Our overarching goal is to develop a systematic approach to quantifying the effect of climate change on cardiovascular health that may be generalizable to a broad range of health conditions and across urban settings worldwide.

Dr. Elisabeth Riviello is Assistant Professor of Medicine at Harvard Medical School and Attending Physician in Pulmonary Critical Care Medicine at Beth Israel Deaconess Medical Center. She is also an Affiliate of the HMS Department of Global Health and Social Medicine, and Honorary Associate Professor of Emergency Medicine and Critical Care at the College of Medicine and Health Sciences at the University of Rwanda. Dr. Riviello completed her undergraduate work at Harvard College, medical school at Vanderbilt School of Medicine, and MPH at the Harvard School of Public Health. Dr. Riviello’s passion is to improve care for critically ill patients in resource-poor settings. She has analyzed the critical care evidence that stems from resource-rich settings in order to rationally apply it to resource-poor settings; developed protocols and educational materials for resource-constrained settings; and collaborated with colleagues at clinical and academic sites in Africa to develop improved models of care delivery. Dr. Riviello’s research seeks to improve context-specific evidence. Her work has included the creation of a mortality prediction model for resource-poor settings, analysis of antimicrobial resistance in sepsis in Rwanda, the use of lung ultrasound as a modality for examining acute respiratory failure in low resource settings, and investigation of epidemiology and outcomes of the Acute Respiratory Distress Syndrome (ARDS) in Rwanda. 

Project Title: BREATHE: Building Respiratory support in East Africa Through High flow versus low flow oxygen Evaluation

Project Description: Acute hypoxemic respiratory failure is a common and deadly component of critical illness in low-income countries (LICs). Even before COVID-19, the burden of hypoxemic critical illness in LICs was enormous, with pneumonia being the leading infectious cause of death worldwide, and hypoxemia causing additional mortality in other infections including malaria, tuberculosis, and resuscitated sepsis, as well as non-communicable diseases such as heart failure, asthma/COPD, cancer, and trauma. Our study at a Rwandan referral hospital before COVID-19 found 12% of all adult inpatients to be hypoxemic, with 60% receiving inadequate oxygen therapy and a mortality rate of 50%. Both oxygen and mechanical ventilators, the oxygen delivery systems used for the most critically ill patients, are extremely limited resources in LICs. High flow nasal cannula oxygen therapy (HFNC) is a system of delivering mixed humidified and heated oxygen and ambient air at flow rates up to 60 liters per minute through a large nasal cannula. HFNC has been shown to decrease mortality and the need for intubation in adults with acute hypoxemic respiratory failure in high-income countries (HICs). In LICs, the potential for mortality benefit from HFNC is even greater because safe mechanical ventilation is largely unavailable. In addition, since HFNC improves oxygenation through positive pressure generated by both oxygen and ambient air rather than oxygen alone, mildly hypoxemic patients may use less oxygen to achieve the same saturation, thus conserving this scarce resource. This project aims to evaluate the mortality benefit of HFNC for critically ill hypoxemic adults in Rwanda while rigorously assessing the feasibility of the intervention for sites across Africa.