Current and Past Fellows
Since commencement, the Burke Fellowship has successfully sponsored groundbreaking research with individuals in the field of global health. Please view the lists below for updates and information about past and current Burke Fellows.
Kavitha Ranganathan, MD
“The Burke Global Health Fellowship is critical for my development as a surgeon-scientist focused on understanding why people become poor as a result of surgery. With this support, I will be able to evaluate both short and long-term outcomes among trauma patients to define the impact that out-of-pocket costs can have on social determinants of health and clinical outcomes in the setting of surgical disease processes. This funding will allow me to translate these initial findings into intervention-based studies in the future.”
Dr. Kavitha Ranganathan is Assistant Professor of Surgery at Harvard Medical School and Director of Craniofacial Reconstruction within the Division of Plastic and Reconstructive Surgery at Brigham and Women’s Hospital. She is also part of the Center for Surgery and Public Health and Program of Global Surgery and Social Change. Dr. Ranganathan attended Northwestern University as part of the Honors Program in Medical Education for her undergraduate and medical school education. She completed plastic surgery residency at the University of Michigan and craniofacial fellowship at Johns Hopkins. From a clinical perspective, Dr. Ranganathan focuses on trauma and cancer reconstruction. From a research perspective, Dr. Ranganathan is focused on defining the burden of impoverishing expenditures among surgical patients locally and internationally. Her ultimate goal is to design and test interventions to alleviate the burden of impoverishing expenditures due to surgery in low- and middle-income countries.
Project Title: Defining the Impact of Trauma on Social Determinants of Health: Unintended Costs and Consequences
Project Description: Every year over 150 million people are impoverished as a result of medical expenses. While the World Health Organization, World Bank, and United Nations have uniformly championed the importance of financial risk protection against the cost of illness, little is known regarding the magnitude of out-of-pocket expenses in the context of surgical care. In India specifically, over 1.2 million people sustain burn and trauma-related injuries each year, with over 700,000 requiring hospital-based interventions. The magnitude of out-of-pocket expenses from direct (medical expenses), direct non-medical (food, transportation, lodging), and indirect (lost wages) sources remains unclear. In this study, we will define the burden of out-of-pocket expenditures among trauma patients with the goal of developing feasible strategies for financial risk protection in collaboration with the All India Institute of Medical Sciences in New Delhi, India. Our central hypothesis is that trauma patients who incur catastrophic expenditures will not only have worsened health outcomes, but will also suffer from worsened social determinants of health including financial insecurity, food scarcity, education, and unemployment. Specifically, we will evaluate changes over time in household wealth, food scarcity, education, employment, and financial security based on the degree of out-of-pocket expenditures incurred among those presenting for management of trauma and burns in India. The individual-level data collected in this proposal will educate future health financing strategies implemented in the form of randomized controlled trials designed to offset costs from surgical patients to national health plans.
Matthew Gartland, MD
“The Burke Fellowship will be a springboard for my career in global health education, giving me the opportunity to develop an innovative education model and to build my teaching and leadership skills.”
Matthew Gartland, MD, is the Director of the MGH Asylum Clinic at the MGH Center for Global Health and a faculty member in the MGH for Children Division of Pediatric Global Health. The MGH Asylum Clinic is a volunteer-driven organization whose mission is to perform forensic medical and psychological evaluations for survivors of persecution and torture seeking asylum in the United States. Dr. Gartland’s academic interests include multidisciplinary medical education, trauma-informed care, and health and human rights in detention-settings. Dr. Gartland has worked extensively around the world on projects related to pediatric HIV and primary care in Mexico, Kenya, Zambia, and Liberia. He earned his BA from Harvard College and his MD from Vanderbilt University. He completed residency in Internal Medicine and Pediatrics at Massachusetts General Hospital. Dr. Gartland is a Hospitalist at Brigham and Women’s Hospital and an Instructor at Harvard Medical School.
Project Title: Asylum Medicine: An Advanced Course on Forensic Medical Evaluations
Project Description: In 2017, more than a quarter of a million people applied for asylum in the United States. Asylum may be granted to a person who is unable or unwilling to return to their home country because of a well-founded fear of persecution on the basis of race, religion, nationality, political opinion or membership in a particular social group. Clinicians can play an essential role by performing forensic medical evaluations of asylum seekers to document critical evidence of the physical and psychological harm resulting from past abuse. Non-clinicians also play a key role by leading program development that addresses the unique needs of asylum seekers, including the use of a skilled and sensitive approach that acknowledges asylum seekers’ complex trauma histories. The core skill set needed to perform effective forensic medical evaluations draws from many different disciplines, necessitating collaboration and team-based care.
I will utilize a Participatory Curriculum Development approach to convene a meeting of community stakeholders and to design and implement a multi-disciplinary seminar titled, Forensic Medical Evaluations of Asylum Seekers in the United States: An Advanced Multidisciplinary Course. The target audience of students for the course crosses multiple levels of training including undergraduates, medical students, trainees, and faculty; and multiple disciplines including social work, clinical psychology, human rights, law, and medicine. The course will encourage cross-fertilization of knowledge and experience, an education environment that closely matches the cross-discipline work that takes place in real-world global health projects.
Oludare Odumade, MD, PhD
“The Harvard Global Health Institute Burke Global Health Fellowship is supporting the development and implementation of a collaborative international research surveillance protocol aimed at reducing the global burden of mortality and morbidity in neonatal sepsis due to antibiotic-resistance pathogens in Benin, Nigeria. I am grateful for this opportunity to expand my work as a scientist, a mentor, and a future leader on a global level.”
Dr. Oludare (Dare) Odumade, MD/PhD, is a clinical instructor and attending physician in the Division of Medical Critical Care Intermediate Care Program at Boston Children’s Hospital and Harvard Medical School in Boston, MA. She received her undergraduate education at Hamline University, Saint Paul, MN, and her medical and graduate degrees at the University of Minnesota Medical Scientist Training Program, Minneapolis, MN. Dr. Odumade began her global infectious diseases research as a Doris Duke Charitable Foundation International Clinical Research Fellow at the Kenya Medical Research Institute (KEMRI) in Kisumu, Kenya. She went on to her pediatric residency at University of California-San Diego, CA, after which she entered the Boston Children’s Hospital (BCH) Global Pediatric Research Fellowship. She then joined the BCH Precision Vaccines Program (PVP), which focuses on the ontogeny of innate and adaptive immunity as it impacts age-specific vaccinology. As a faculty in the PVP, she works on several NIH-funded and philanthropic projects aimed at understanding the immune system and vaccine development. Dr. Odumade’s overall focus involves projects in child and maternal health aimed at understanding, from a global perspective, 1) what causes neonatal sepsis, 2) develop better tools for low-middle income countries to diagnosis sepsis, 3) identify immunological risk factors for developing neonatal sepsis in order to inform novel target of interventions and 4) develop preventative strategies (such as vaccines) and therapeutics targets (i.e. antibiotics that pathogens are susceptible to).
Project Title: CERHI-Benin And BCH-Global Health Collaborative on Translational Research on Pediatric Sepsis (CAB-TRAPS)
Project Description: Infant mortality due to neonatal sepsis remains an important but poorly understood global health burden and neonatal sepsis accounts for approximately 22% of under-5 mortality. The lack of improvement in mortality, in the last two decades, due to neonatal sepsis is multifactorial and includes difficulties in the diagnosis of sepsis, maternal factors such as maternal infection (i.e. chorioamnionitis), infant factors such as increased vulnerabilities due to a distinct neonatal immune system with reduced antibacterial mechanisms, and increased antimicrobial resistance. In low- and middle-income countries (LMICs) such as Nigeria, where the likelihood of death from sepsis is higher; there is a paucity of data on what pathogens cause infection and local or regional antimicrobial resistance patterns (AMRs). This is important because the difference between life and death can simply be the incorrect choice of antibiotics. Hence, there is a need to work with local stakeholders such as epidemiologists, physicians, nurses, assistants, and laboratory staff to characterize local pathogens and local AMR patterns. Secondly, it is important to develop assays to understand the interactions between the immune system and various infections. This project, funded by the Burke Fellowship, will launch a collaborative long-term bi-directional international research surveillance protocol between Boston Children’s Hospital (BCH), Boston, Massachusetts, and the Centre of Excellence in Reproductive Health Innovation (CERHI), Benin City, Nigeria to study neonatal sepsis by characterizing regional AMRs and implementing a pilot lab training protocol based on a prospective maternal-infant cohort from which bio-samples for future down-stream technologically advanced clinical and research platforms are collected and stored. The long-term goal is to build capacity and improve sustainability through research opportunities for trainees including lab-based training and co-writing of both grants and peer-reviewed manuscripts.
John Naslund, PhD
“I am honored to be a recipient of the Burke Fellowship, and to have this exciting opportunity to expand my research in collaboration with Sangath to use widely available digital technology to address stress and to promote mental health and wellbeing among community health workers in rural India. This project represents a critical part of my research and career development, because it will set the stage for supporting the eventual roll out of this scalable digital program in low-resource settings, and is especially timely given the devastating impact of the COVID-19 pandemic across the country, and urgent need to address the resulting psychological distress and elevated risk of burnout among community health workers on the frontlines.”
Dr. Naslund is Instructor of Global Health and Social Medicine at Harvard Medical School. He holds expertise in psychiatric epidemiology, implementation science, and digital mental health. Dr. Naslund's scholarship seeks to address early mortality that disproportionately impacts individuals living with serious mental illnesses worldwide, and to reduce the global care gap for mental disorders using novel digital methods. Dr. Naslund has led numerous projects that leverage mobile technologies, social media, and online big data to develop, evaluate, and implement digital interventions aimed at treating and preventing serious mental disorders, and addressing symptoms of mental illness and risk factors for early mortality in young persons living with mental illness. He currently leads the scientific activities of ESSENCE (Enabling Science to Service to ENhance depression CarE), one of ten National Institute of Mental Health funded U19 Scale Up Hubs involving the use of digital technology for scaling up evidence-based mental health interventions delivered by community health workers in the state of Madhya Pradesh, India. Dr. Naslund is also supported by grants from the Brain & Behavior Research Foundation, Grand Challenges Canada, and Wellcome Trust, and has over 120 peer-reviewed publications. Dr. Naslund co-leads the Mental Health for All Lab at Harvard Medical School, and is an Honorary Research Fellow with Sangath, a world leading NGO and research organization based in India. Dr. Naslund has a longstanding track record advocating for the rights, dignity, and quality of healthcare for those living with mental illness.
Project Title: Developing a scalable digital program for stress reduction and mental health promotion for community health workers in rural India
Project Description: Community health workers (CHWs) represent the backbone of most health systems, particularly in low-income and middle-income countries (LMICs), such as India, where they are responsible for delivering essential primary health care services in remote communities and underserved settings. CHWs are now increasingly playing a critical role in efforts to scale up mental health care globally, referred to as task sharing. Despite recent initiatives to strengthen health systems and improve performance of CHWs, through supervision, better training, and improved data collection, one notable gap in the global health literature is the limited attention to the mental health and wellbeing of CHWs themselves. This is a major concern because CHWs in LMICs face high levels of stress, driven by high work demands, low compensation, and facing adversity such as poverty, gender inequality, and being at the bottom of health system power hierarchies. The COVID-19 pandemic has significantly exacerbated risks of psychological distress and burnout among CHWs on the frontlines. It seems intuitive that mentally healthy and motivated CHWs will be better positioned to deliver high quality care to their patients, and as a result, support the successful implementation of mental health care. Our study seeks to address this gap by developing and pilot testing a digital stress reduction and mental health promotion program for CHWs embedded within an ongoing large-scale NIMH U19 implementation project called ESSENCE (Enabling Science to Service to ENhance depression CarE) focused on scaling up mental health services in primary care in rural India. This Burke Fellowship builds on our team’s track record using digital technology for training and supporting CHWs, and will first involve developing a scalable digital stress reduction program for CHWs in rural India by adapting the World Health Organization’s evidence-based Self Help Plus intervention for psychological distress to fit the local context and culture, while digitizing the content so that it is entirely accessible from a smartphone app. Next, we will conduct a pilot study to evaluate the feasibility, acceptability and preliminary effectiveness of the digital stress reduction program for CHWs. Lastly, we will explore whether reducing stress among CHWs may impact their wellbeing and the quality of care they deliver. Our exploratory findings hold promise for offering a scalable approach for reducing stress to support frontline health workers in delivering evidence-based mental health services in low-resource settings. This study could also inform efforts to alleviate the added burden and elevated stress levels and risk of burnout among CHWs in LMICs due to the ongoing response to the COVID-19 pandemic.
Adeline A. Boatin, MD, MPH
“The Burke fellowship will provide the support to expand my research from a single institution to a national health system level, and to explore emerging and novel aspects of cesarean delivery provision in sub-Saharan Africa, thus placing me at the forefront of global researchers targeting this important aspect of safe motherhood.”
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 PhD
“Through the Burke Global Health Fellowship, we will train data specialists and clinical practitioners together in Madagascar. This will build long term capacity for curiosity-driven, solutions-based research to improve one the least supported health systems in the world.”
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.
Dhruv S. Kazi, MD, MSc, MS
“I am thrilled to receive a Burke fellowship from the Harvard Global Health Institute. For me, understanding the impact of climate change on Mumbai’s health system is deeply personal – it is where I grew up and where my parents, extended family, and many of my dearest friends still live. As a cardiologist and outcomes researcher, my prior work has focused on identifying cost-effective and scalable interventions to improve cardiovascular health in the US and overseas. The Burke fellowship will allow me to expand my research portfolio to tackle important questions at the intersection of cardiovascular disease and climate change. It will help me build interdisciplinary collaborations with experts in climate change, public health, and health policy across the Harvard institutions, as well as with researchers and policymakers in India. I look forward to working closely with Dr. Ari Bernstein to help advance our understanding of what I believe are two of the biggest threats to global health today.”
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.
Elisabeth D. Riviello, MD, MPH
“The Burke Global Health Fellowship is making it possible for me to transition my research from analyzing the epidemiology of critical illness in LICs, to investigating an intervention to improve outcomes among critically ill patients in LICs. I am grateful for this unique opportunity to launch a new phase of my career.”
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.
Satchit Balsari, MBBS, MPH
Dr. Satchit Balsari is Assistant Professor in Emergency Medicine at Harvard Medical School (Beth Israel Deaconess Medical Center), and in Global Health and Population at Harvard Chan. Until March 2017, he served as Chief of the Weill Cornell Global Emergency Medicine Division in New York. Balsari’s research is focused on the application of mobile and cloud-based technologies to protect the health of populations marginalized by disasters and war. His signature initiatives include EMcounter, a portable digital surveillance tool deployed at the world’s largest mass gatherings; Voices, a crowd-sourced, online disaster response analysis tool; and the Hurricane Maria Mortality Study (co-led with Professor Caroline Buckee), that refuted the US government’s low death toll in post-hurricane Puerto Rico.
Balsari directs the India Digital Health Network (IDHN), an interdisciplinary faculty initiative at Harvard’s Lakshmi Mittal South Asia Institute, advancing digital health implementation science in India. IDHN’s white papers have contributed to shaping both the architecture and data protection policy for health data exchange in India.
Dr. Balsari has developed a range of domestic and international courses in global health and mobile technology, taught in India, Sri Lanka, South Africa, and the US. At Harvard, he co-directs the university-wide course, “Entrepreneurial Solutions to Intractable Social Problems,” and “Societal Response to Disasters” at HSPH.
Dr. Balsari is faculty at the Harvard FXB Center for Health and Human Rights. He is recipient of the Dr B.C. Roy National Award presented by the President of India; an Aspen Ideas Scholar, and an Asia 21 Fellow of the Asia Society.
Project Title: Testing the readiness of (big) health data in India for advanced analytics and AI
Burke Fellowship Research Abstract:
Billions are being invested in big health data analytics and AI to develop decision making and prediction tools that aim to improve how, when, where and why we seek care. However, fundamental questions about how health data may be used, collated, anonymized, exchanged, sold, traded or analyzed are yet to be answered. International jurisprudence around these issues is still developing: empiric testing is now required to find the right balance between the desire to leverage vast amounts of data for secondary use, with the need to protect an individual’s privacy and safety.
A series of simultaneous legislative and judicial developments are currently shaping the contours of privacy rights and data protection in India. The country’s newly launched federal health insurance scheme, targeting 500 million people, is expected to help seed India’s digital health ecosystem. My research seeks to test the “AI readiness” of healthcare data in India, in this evolving context. In particular, I will examine state-level health data to: I) examine best practices in data aggregation and anonymization by simulating merger of large public health databases; II) prepare data for differential access (and secondary use) by third-parties; III) examine the adequacy of existing domestic laws and key international guidelines in protecting privacy, promoting transparency and enabling the generation and availability of (big) health data.
Stéphane Verguet, MS, MPP, PhD
Stéphane Verguet, MS, MPP, PhD, is an Assistant Professor of Global Health in the Department of Global Health and Population at the Harvard T.H. Chan School of Public Health. He has two main areas of research, both related to health systems, health economics, and priority setting: (1) the incorporation of the dimensions of equity and financial risk protection into the economic evaluation of health policies with the development and application of the “extended cost-effectiveness analysis” (ECEA) methodology; (2) health system analysis and performance, including the study of the interaction and integration of health services delivery platforms and health system modeling. He holds an MPP as well as an MS and PhD in Mechanical Engineering from the University of California at Berkeley, and is a graduate of the Ecole Polytechnique.
Project Title: Developing a distributional population health metric that incorporates health inequalities and illness-related poverty
Burke Fellowship Research Abstract:
Cost-effectiveness analysis (CEA) estimates the aggregate health gains (as disability-adjusted life years, or DALYs, averted) per given expenditure on a single health intervention. However, beyond this partial view, multiple other outcomes of policy should be incorporated in CEA. Financial risk protection (FRP) and improvement of the distribution of population health are two major objectives in the pursuit of universal health coverage (UHC). CEA, and DALYs, should in fact include the distributional impact of health policies per population subgroup (e.g. socioeconomic status) and their FRP benefits (i.e. avoiding impoverishment from illness-related out-of-pocket expenditures). This would enable identifying ‘best buys’ in terms of equity and poverty reduction gains when investing in interventions toward UHC. We propose to create a distributional population health metric that extends the DALY beyond total health to include health inequalities and FRP.
Ashley Whillans, PhD
Ashley Whillans, PhD is an Assistant Professor of Business Administration at the Harvard Business School, and a member of the Harvard Kennedy School's Behavioral Insights Group. She is also a Faculty Affiliate of the Business and Environment Initiative (HBS), the Human Flourishing Program (Public Health), and the Mind Brain and Behavior Interfaculty Initiative. She received her PhD in Social Psychology from the University of British Columbia in November, 2017 and at HBS in July, 2017. During her PhD, her research was funded by the Social Sciences and Humanities Research Council of Canada, and her PhD Dissertation won the CAGS Distinguished Thesis Award for being the single best dissertation in Canada across the fine arts, social sciences, and humanities. In 2015, she was an advisor for the White House Social & Behavioral Sciences Team. In 2016, she co-founded the Department of Behavioral Science in the British Columbia Provincial Government. She is also part of the UN Global Happiness Thematic Council and advises on the well-being strategy of numerous non-profit and for-profit partners. In 2015 and 2018, she was named a Rising Star of Behavioral Science by the International Behavioral Exchange & Behavioral Science and Policy Association. In 2019, she was one of three faculty across Harvard to be named a Burke Family Foundation Global Public Health Fellow. Thus, Prof. Whillans has extensive experience with and has been recognized for her ability to use social science to address large-scale social problems. Broadly, Prof. Whillans' research focuses on understanding how decisions about time and money impact well-being. Her research has been published in 20+ academic outlets, including Science Advances, Nature Human Behavior, and the Proceedings of the National Academy of Science. Prof. Whillans is passionate about science communication and has written about her research for outlets including the Harvard Business Review, The New York Times, The Washington Post, The LA Times, and The Wall Street Journal. Her first trade-book “Time Smart: How to Reclaim Your Time and Live a Happier Life” will be published by Harvard Business Publishing in September 2020.
Project Title: Alleviating Time Poverty Among the Working Poor
Burke Fellowship Research Abstract:
Poverty entails more than just a scarcity of material resources—it also involves a shortage of time. People living in extreme poverty, particularly those living in developing countries, spend significantly more time on unpaid labor as compared to those who are wealthier. Research suggests that poor girls and women are disproportionately affected. For example, girls and women living in rural India spend an average of 6.1 hours/day on unpaid labor, undermining their ability to attend school, obtain paid work, and invest in the development of their children. In this research, we seek to investigate whether and how relieving time poverty can have psychological, economic, and health benefits for girls and women living in the Jaisalmer region of Rajasthan, India. Of the 672,008 inhabitants of Jaisalmer district, 70% live in rural extremely poor areas that receive very little rainfall. Indeed, Jaisalmer is an arid region of India where water is especially scarce and where water collection involves significant effort for girls and women—making the empirical and practical scope of this research particularly relevant. To test whether alleviating time poverty improves the health, well-being, economic, and educational attainment of girls and women in this area, we are working with a local nonprofit organization OneProsper. Together, we will run an experiment where girls and women will be provided with rainwater collection technology designed to reduce the amount of time spent collecting water. We will collect data on school attendance, crop yield, cognitive and psychological health—including measures of subjective well-being, self-reported stress, physical health, and gender stereotypes. In addition to amassing important data regarding the benefits of rainwater collection technology, the insights generated by this research could inform a new model of aid designed to overcome poverty traps by addressing time poverty. Indeed, in 2016, Melinda Gates wrote a “Gates Note” on this issue and created a video called “Time Poverty: The Gap that No One’s Talking About” highlighting the fact that in every part of the world women spend more time on unpaid work than men. She wrote that “the massive hours that girls spend on household tasks distorts their entire lives.” By combining the rigorous methods of experimental economics with recent insights from social psychology, and by working together with researchers at various local institutions, this project will catalyze interdisciplinary research and collaboration between researchers in the US and in South East Asia. We plan to use the insights from this initial research to apply for larger grants through the NSF and Gates Foundation to understand the long-term positive impacts of reducing the burden of unpaid labor for girls, women, and families living in developing countries.
Maha Farhat, MD, MSc
Maha Farhat is Assistant Professor of Biomedical Informatics at Harvard Medical School. She holds an MD from the McGill University Faculty of Medicine and an MSc in biostatistics from the Harvard T.H. Chan School of Public Health. Maha is also a practicing physician at the Massachusetts General Hospital Division of Pulmonary and Critical Care Medicine.
Maha’s research focuses on the development and application of methods for associating genotype and phenotype in infectious disease pathogens, with a strong emphasis on translation to better diagnostics and surveillance in resource-poor settings. To date, Farhat's work has focused on the pathogen Mycobacterium tuberculosis and spans the spectrum from computational analysis to digital epidemiology. She is a PI and Co-Investigator on several large projects funded by NIH including the NIAID and the BD2K initiative.
Project Title: A Big Data Approach to Tuberculosis and Drug Resistance Epidemiology
Burke Fellowship Research Abstract:
Tuberculosis (TB) remains a major global public health threat. In 2016 alone, there were an estimated 10 million TB cases globally and over a million deaths. One of the most challenging and morbid forms of TB is caused by multidrug resistant (MDR) Mycobacterium tuberculosis, with a global annual incidence of nearly half a million cases and rising. Limited declines in TB incidence and rising rates of resistance are at least in part symptoms of struggling local health systems challenged by difficulties in surveilling and diagnosing this disease due to its microbiological hazard and slow growth in culture, in addition to difficulties in delivering the required 6-24 months of relatively toxic therapy. Tuberculosis is in sore need of innovation that can help reform systems, direct resources and improve treatment outcomes. Whole genome sequencing is an emerging tool for diagnosing antibiotic resistance in tuberculosis, however to date the large number of publicly available whole genome sequences have not been capitalized on sufficiently to guide surveillance and improved care. In addition to public whole genome sequence (WGS) data there is an increasing amount of internet based ‘big’ data that if rigorously integrated and analyzed holds considerable promise to modernize tuberculosis epidemiology and surveillance. Maha has proposed to leverage her interdisciplinary background in medicine, biostatistics, and informatics to create a world map of Mycobacterium tuberculosis antibiograms and investigate a potential association between pollution rates and TB incidence in India.
Daniel Palazuelos, MD, MPH
Daniel Palazuelos is a global health implementer and educator who holds a variety of positions across Harvard, including, Associate Physician in the Department of Medicine, Assistant Director of the Hiatt Global Health Equity Residency in the Division of Global Health Equity, Clinician-Educator Hospitalist at Brigham and Women's Hospital, and Cannon Society Global Health Teaching Fellow at Harvard Medical School. Daniel also serves as the Director for Community Health Systems at Partners In Health, and as the Co-founder/Chief Strategist of Compañeros En Salud - México (PIH-Mexico).
In his role for the PIH project in Mexico, Compañeros en Salud-Mexico, he worked to create the strategy for, and successfully launch, the new health care system strengthening. It is envisioned not only as a service provider for local people in the Sierra Madre Mountains of Chiapas, but also as a platform for both U.S. and Mexican medical trainees to learn about global health and to conduct implementation research. In addition to an emphasis on extensive preparation and on-site mentorship, this program offers collaborators the capacity to support intensive and logistically complex research efforts. Noteworthy examples include: a stepped-wedge unidirectional crossover study of the effectiveness of community health worker accompaniment on diabetes and hypertension treatment adherence and clinical outcomes, and a user perception study of how a multifaceted educational intervention has affected local staff career choices.
Project Title: Multi-media Teaching in Global Health and Social Medicine
Burke Fellowship Research Abstract:
All medicine is social medicine, all health is global health; but not all medical trainees learn enough about either to put the best of each field into practice. Although Harvard has made a major commitment to offering these subjects across its many schools, including a mandatory social medicine course during the pre-clinical years at the medical school, there is room to reach even more trainees with new and innovative teaching techniques. Multi-media learning has gained traction as an important pedagogical tool. Harvard medical students have expressed a preference for being introduced to new concepts via such techniques. This fellowship project will combine experiences from several initial successes, including a series of social medicine videos produced for medical students and a highly-trafficked podcast hosted on CHWcentral.org, to explore how such materials can augment learning across the Harvard schools, and beyond.
Giuseppe J. Raviola, MD, MPH
Giuseppe (Bepi) Raviola is Assistant Professor of Psychiatry in the Department of Global Health and Social Medicine at Harvard Medical School. He is Director of Mental Health for Partners In Health (PIH), and Director of the Program in Global Mental Health and Social Change at Harvard Medical School. A board-certified adult and child/adolescent psychiatrist, he is an attending physician at Boston Children’s Hospital.
In the Department of Global Health and Social Medicine, Bepi works to advance efforts related to training and education, and research, seeking to promote excellence in global mental health care delivery in the countries with which the program partners and at HMS. He is a collaborator in the development of a new cross-Harvard initiative, GlobalMentalHealth@Harvard. In his role with PIH he works to integrate mental health services into the care provided at PIH sites, supporting local team leaders in Haiti, Rwanda, Sierra Leone, Liberia, Malawi, Lesotho, Mexico and Peru on issues related to mental health care delivery and program implementation. Bepi’s scholarly contributions center on the integration and application of quality improvement and public health approaches in innovating clinical practice, teaching and research in the domains of psychiatry and global mental health. This work meets a critical local and global need for innovative mental health delivery solutions, given the significant global burden of mental disorders, and the universal shortage of specialists to address this burden.
Project Title: Assessment of the Feasibility of a Service Delivery Planning Matrix to Expand Care for Common Mental Disorders at Four Global Sites
Burke Fellowship Research Project:
Mental disorders are currently the leading cause of disability worldwide, and they most frequently remain unaddressed and untreated due to a lack of access to mental health care. It is estimated that up to 90% of persons with common and severe mental disorders in low- and middle-income countries receive no care for their mental health conditions. Over the past decade PIH has established mental health program teams at each of its global sites, and collaborative cross-site platforms for mental health care delivery, in collaboration with Harvard University and other partners. These teams have developed significant experience in articulating local, decentralized mental health systems of care in collaboration with Ministries of Health. A Common Mental Disorders Care Service Delivery Planning Matrix to Achieve Universal Mental Health Coverage has been developed by a collaborative cross-site PIH mental health team.
The aims of this study are: to use a formal Theory of Change (ToC) approach to further develop this organizational matrix for the delivery of care for common mental disorders across a collaborative of global stakeholders, focusing on four PIH sites (qualitative); and assess the feasibility, acceptability and readiness of local implementing mental health teams at those four sites to adopt quality improvement methods for the delivery of care for common mental disorders such as depression, using a MUSIQ calculator/tool. This study will use on-site screening data which will provide an estimate of the prevalence of common mental disorders, and the ToC map and planning matrix, to generate a comprehensive estimate of the resources needed to achieve levels of effective coverage of interventions at specific sites.
Eugene Richardson, PhD, MD, MA
Eugene Richardson is Assistant Professor of Global Health and Social Medicine at Harvard Medical School and an associate physician in the Division of Infectious Diseases at Brigham and Women’s Hospital. He received his MD from Cornell University Medical College and his PhD in Anthropology from Stanford University. He completed his residency in internal medicine and a fellowship in infectious diseases and geographic medicine at Stanford University Medical Center.
As an infectious disease physician and critical medical anthropologist, Eugene conducts biosocial research on epidemic disease in sub-Saharan Africa. Prior to his appointment at HMS, he served as the clinical lead for Partners in Health’s Ebola response in Kono District, Sierra Leone, where he now conducts regional mixed-methods research projects related to the 2013-16 Ebola outbreak. He has also worked as a clinician for Médecins Sans Frontières, a World Bank consultant for HIV prevention in Swaziland, and a research scientist at the Desmond Tutu HIV Centre, University of Cape Town, South Africa.
Project Title: Estimating the True Burden of Ebola Virus Transmission During the 2013-16 Outbreak in West Africa
Burke Fellowship Research Abstract:
The 2013-16 Ebola virus disease (EVD) epidemic in West Africa was the largest in recorded history and was the result of dysfunctional health services, a highly mobile and interconnected population, low public trust in government, burial practices that involved contact with contagious Ebola-infected corpses, and provision of care to infected individuals. Despite over 28,000 reported cases, our understanding of the epidemiology of EVD is limited, including empirical data explaining why this outbreak was so much larger than previous ones. A major gap in the knowledge base is the prevalence and distribution of undocumented survivors, since 1) an estimate of their numbers could help correct for underreporting of cases; and 2) an understanding of how these individuals fell outside of the international containment response could help bolster preparedness for future outbreaks.
The overall goal of this study is to investigate the prevalence and distribution of undocumented EVD survivors in West Africa. Eugene’s main hypotheses are that there are hundreds—if not thousands—of undocumented survivors in the region and that the lack of adequate treatment facilities played a key role in deterring compliance with containment measures.
Renee N. Salas, MD, MPH, MS
Renee Salas is a clinical instructor of emergency medicine at Harvard Medical School and an emergency medicine physician at the Massachusetts General Hospital (MGH). She received her Doctor of Medicine from the innovative five-year medical school program to train physician-investigators at the Cleveland Clinic Lerner College of Medicine. She concurrently obtained a Master of Science in Clinical Research from the Case Western Reserve University School of Medicine. Subsequently, she received a Master of Public Health from the Harvard T.H. Chan School of Public Health with a concentration in environmental health while completing a Fellowship in Wilderness Medicine at MGH. She was also the recipient of the 2018 MGH Clinician-Teacher Development Award. She has directed her career towards an academic concentration on climate change and health with research focused on addressing the current pressing knowledge gaps in this field. She is a nationally recognized leader on this subject in emergency medicine and is the lead author for the 2018 Lancet Countdown brief for the United States.
Project Title: Impact of Billion-Dollar Weather and Climate Disasters on Healthcare Utilization, Outcomes, and Cost for Elderly Medicare Beneficiaries
Burke Fellowship Research Abstract:
The Lancet Commission on Health and Climate Change has declared climate change “the biggest global health threat of the 21st century.” Globally, climate change is having the biggest health impacts on populations in developing countries, which have contributed least to the emission of the greenhouse gases stimulating this phenomenon. Specifically, climate change is causing an increased frequency and/or severity of extreme weather events. While we know extreme weather events negatively impact health and increase the utilization of healthcare, current studies are limited in scope and applicability. As is true globally, the most affected populations typically are those with the fewest resources and with baseline medical and social vulnerability, such as the elderly. Furthermore, displacement from extreme weather and climate events and the health impacts of displacement are not well understood despite the huge prevalence worldwide with over 24 million individuals displaced in 2016 alone.
Large longitudinal comprehensive datasets, such as Medicare beneficiaries within the United States, are rare worldwide. However, for this project we will utilize this dataset to assess healthcare utilization, outcomes, and cost of certain extreme weather events in elderly Medicare beneficiaries. Most importantly, it will allow the assessment and exploration of the hypothesis that population displacement is an independent predictor of worse health outcomes. Understanding the health and healthcare impacts of climate change driven extreme weather within the U.S., and specifically population displacement, has significant global health implications including informing evidence-based prevention. In addition, this work will potentially engage critical healthcare sectors in the U.S. with implications for optimizing mitigation efforts with significant subsequent global health benefits.
Jose F. Figueroa, MD, MPH
Jose Figueroa is an Instructor of Medicine at Harvard Medical School and an Associate Physician at Brigham & Women’s Hospital. He graduated from Harvard Medical School and the Harvard School of Public Health in 2011 and he completed his residency in Internal Medicine at the Brigham & Women’s Hospital, where he now serves as Faculty Director of the BWH Residency Management & Leadership Track. Jose previously worked at GAVI, the Vaccine Alliance. His main research interests include 1) identifying needs and successful models of care for high-need, high-cost populations, 2) improving health equity, and 3) evaluating the impact of pay-for-performance efforts globally on health care quality and costs. Most recently, Jose has been developing and evaluating the quality framework for a large-scale pay-for-performance intervention in rural China directed at county hospitals responsible for the care of over 63 million people.
Project Title: Impact of Financial Incentives to Promote Hospital Quality in Rural China
Burke Fellowship Research Abstract:
Recently, China completed the largest insurance enrollment in human history, with approximately 1.2 billion citizens enrolled. A major focus of this reform now is to ensure China achieves better health outcomes at an affordable price. As a result, China is currently investing on large-scale experiments with different payment models to promote quality. One promising model is a multi-year pay-for-performance project aimed at Chinese rural hospitals called project APPROACH, the Analysis of Provider Payment Reforms on Advancing China’s Health. This project utilizes a mixed payment model, combining a capitated global budget and pay-for-performance incentives, directed at Chinese rural county hospitals. As part of this project, Jose will be leading the effort to identify and validate the quality framework for this large-scale program targeting hospitals that care for a population of over 63 million people. In addition, he will evaluate the impact of this incentive program on the quality of care delivered by Chinese rural hospitals. Insights gained from this project will be valuable for other countries similarly interested in moving towards value-based health systems.
Lindsay Jaacks, PhD
Lindsay Jaacks is an Assistant Professor in the Department of Global Health and Population at the Harvard T.H. Chan School of Public Health and a Visiting Professor at the Public Health Foundation of India in Delhi. Prior to her appointment at Harvard Chan, she completed a Postdoctoral Fellowship at the Emory Global Diabetes Research Center in Atlanta. Lindsay has served as a consultant to the U.K. Department for International Development on addressing overweight/obesity in low-income countries, and is currently serving as a consultant to RTI International on estimating the impact of food and nutrition policies on diabetes.
The overarching vision of Lindsay’s research program is to advance our knowledge of the intersection between the food system and health system with respect to cardio-metabolic health, and to apply that knowledge to develop interventions to halt the increase in obesity and diabetes, particularly in low- and middle-income countries. Her current projects can be characterized by two broad categories: 1) those addressing primary prevention (exposures in the food system) of obesity and diabetes, and 2) those addressing secondary prevention (health system performance) of cardio-metabolic diseases. Projects include both observational and intervention studies using quantitative and qualitative approaches, and, importantly, span the biochemical-population spectrum.
Project Title: Association of Pesticide Exposures with Infant and Child Growth in Rural Bangladesh
Burke Fellowship Research Abstract:
Children around the world are not reaching their full potential. In South Asia, over a third of children under 5 are stunted. Innovative interventions and programs targeting in utero exposures are needed to address this significant global disease burden. Endocrine disrupting chemicals, including some pesticides, have been linked to impaired child development including intrauterine growth restriction and low birth weight. Few studies have explored these associations in South Asia, where more women are directly engaged in agriculture and therefore in utero exposures are likely higher. Lindsay’s project will leverage stored samples from a prospective birth cohort study in rural Bangladesh, which enrolled 1613 women between 2008 and 2011. Between 2010 and 2013, children born to mothers in the original study were invited to participate in follow-up studies. Stunting outcomes were available for 618 children. Stored baseline (≤16 weeks gestation) maternal urine samples (n=300) will be analyzed for the following contemporary-use pesticides or their metabolites: 2,4- 2,4-D and 2,4,5-T (herbicides); a metabolite of Diazinon, a metabolite of Chlorpyrifos, a metabolite of Malathion; four Pyrethroid metabolites; and a metabolite of Parathion. Multivariable regression models will be used to assess associations between early pregnancy levels of pesticides and birth weight, low birth weight, preterm birth, height-for-age, stunting, and head circumference. From her initial research, no study has explored the association of exposure to these pesticides in utero and infant and child growth outcomes in Bangladesh. Thus, results of this innovative project will provide new insights into the effects of these modifiable exposures, and potential targets for future interventions.
Gautam Rao, PhD, MS
Gautam Rao is an Assistant Professor at the Department of Economics at Harvard University, a Faculty Research Fellow at the National Bureau of Economic Research (NBER), and a faculty affiliate at the Jameel Poverty Action Lab (JPAL). His research seeks to bring insights from psychology to bear on topics in development economics. Recent and ongoing projects include studying how to increase the take-up and success of commitment contracts for preventive health in rural India; the effect of depression on economic preferences and behaviors; the economic and health consequences of sleep deprivation among the urban poor in India; and how mixing rich and poor students in schools in India affects social preferences and behaviors.
Project Title: The Economic and Health Consequences of Improving Sleep among the Urban Poor
Burke Fellowship Research Abstract:
A large body of medical research has shown that sleep deprivation adversely affects outcomes ranging from pain sensitivity to cognitive and cardiovascular function. Much of this evidence comes from sleep labs in the developed world, where sleep can be carefully manipulated, and short-run physiological and cognitive outcomes precisely measured. In contrast, little is known about the prevalence and consequences of sleep deprivation among individuals in the developing world, especially those in urban settings who may be exposed to conditions such as heat, noise, over-crowding and uncomfortable living conditions. Gautam plans to provide the first objective measures of sleep in a developing country and implement an RCT to improve sleep among 500 low-income adults in Chennai, India. This RCT evaluates scalable interventions to improve sleep – the provision of sleep-aid devices for use at home and a 30-minute afternoon nap at the participants’ work site – and studies the impact of improved sleep on a variety of health and economic outcomes over a period of one month in a “real-world” environment. Promisingly, based on numerous small-scale pilot studies, Gautam expects the two interventions to increase daily sleep by over an hour.
Gustavo E. Velásquez, MD, MPH
Gustavo E. Velásquez is an Associate Physician in the Division of Infectious Diseases at Brigham and Women’s Hospital. He is an Instructor in Medicine and a Research Associate in Global Health and Social Medicine at Harvard Medical School. Gustavo received his MD from the Northwestern University Feinberg School of Medicine and his MPH from the Harvard T.H. Chan School of Public Health in 2009. He completed the Doris and Howard Hiatt Residency in Global Health Equity and Internal Medicine at Brigham and Women’s Hospital in 2013 and fellowship in Infectious Diseases at Massachusetts General Hospital and Brigham and Women’s Hospital in 2015.
Gustavo’s research has examined the optimal construction of regimens to treat multidrug-resistant tuberculosis (MDR-TB) in Tomsk, Russian Federation, and evaluated the association between HIV coinfection and pyrazinamide resistance on TB outcomes in Lima, Peru. He is currently collaborating with Dr. Carole Mitnick and her team on: 1) the analysis of a Phase II clinical trial (HIRIF, NCT01408914) examining the potential of high-dose rifampin to shorten standard TB therapy in Peru, 2) the implementation of a Phase III clinical trial (endTB, NCT02754765) evaluating the efficacy and safety of new MDR-TB treatment regimens in Georgia, Kazakhstan, Kyrgyzstan, Lesotho, Peru, and South Africa, and 3) the implementation of a pharmacokinetic/pharmacodynamic (PK/PD) sub-study nested in the endTB trial.
Project Title: Novel and Repurposed Drugs for Multidrug-Resistant Tuberculosis: Targeting Toxicity to endTB
Burke Fellowship Research Abstract:
In 2015, less than a quarter of the 580,000 new patients requiring treatment for MDR-TB received appropriate treatment. Those who did, suffered from toxicities including nausea, vomiting, arthralgia, diarrhea, nephrotoxicity, and hepatotoxicity, during at least 18 months of daily treatment. Consequently, treatment is poorly tolerated and loss to follow-up occurs among nearly one quarter of patients, leading to further MDR-TB transmission and disease.
Two new drugs, bedaquiline and delamanid, and two repurposed drugs, clofazimine and linezolid, were recently recommended for MDR-TB treatment. All four drugs are represented in the experimental arms of the “Evaluating Newly Approved Drugs for Multidrug-Resistant TB” Phase III clinical trial (endTB, NCT02754765). The endTB trial, which evaluates the efficacy and safety of new MDR-TB regimens, and its PK/PD sub-study, provide a unique and timely opportunity for an interdisciplinary evaluation of new and repurposed drugs for MDR-TB. This project will be embedded in endTB and its PK/PD sub-study, and will 1) explore whether adverse events are less common with the new regimens, 2) compare the safety and tolerability of two linezolid dose-reduction strategies, and 3) investigate the association between plasma drug exposure and the safety and tolerability of combination regimens.
Margaret Bourdeaux, MD, MPH
Margaret Ellis Bourdeaux’s, MD, MPH , research and field work focuses on three areas: health systems and institutions in fragile and conflict affected states; health sector leadership capacity building in fragile and conflict affected states; and ways to use health systems as a vehicle to address ecological determinants of disease for impoverished people living proximate to fragile ecologies. She works closely with Harvard Medical School’s Global Public Policy and Social Change program and spearheads the Fragile State Health System working group. She earned her B.A. at Harvard University, her M.D. from Yale Medical School, completed her combined residency in Internal Medicine and Pediatrics at Brigham and Women’s Hospital in Boston, MA and completed her MPH at Harvard School of Public Health. She was one of the first graduates of the Global Women’s Fellowship at Brigham and Women’s Hospital. She has worked with the Office of the Secretary of Defense Policy to analyze the US Department of Defense’s global health projects and programs. She led a joint Harvard-NATO team of analysts to evaluate the impacts, challenges and opportunities international security forces have in protecting and rebuilding health systems in conflict affected states. She also serves as a policy advisor for PIVOT, an NGO working to address ecologic determinants of disease by strengthening and supporting the public health system of Madagascar.
Project Title: Preventing Health System Disruption from Armed Conflict in Fragile States: Is Aid Effective?
Burke Fellowship Research Abstract:
War kills people by destroying the institutions necessary to sustain civilian life and livelihoods. In particular, the destruction of health systems leaves countries unable to provide the most basic of health services, often leading to increased rates of death and disability for decades after the cessation of conflict. Recognizing this, most global health aid agencies and donors have embraced calls to funnel more aid to health systems threatened by armed conflict. However, little research exists looking at the effectiveness of this approach: does aid to health systems actually arrive? Does it allow health system to function through periods of crisis? Does it prevent health system collapse?
The purpose of this project is to thoroughly interrogate patterns of aid and financing of health systems in fragile and conflict-affected states over the past two decades. Leveraging new data sources, statistical methods and the network of relationships the Global Public Policy and Social Change program at Harvard Medical school has cultivated with leaders of health systems in fragile settings, I will examine how public, private and donor aid has fluctuated over time in nine fragile and conflict affected states. Then I will assess the longitudinal relationship between health system financing and changes in health system functioning, such as disruptions of health worker salary disbursements and health service provision. Interviews with key stakeholders including health system policy makers, donor agency personnel and health care providers will be used to corroborate and explore in more depth patterns identified in during quantitative analysis.
Lydia Pace, MD, MPH
Lydia Pace, MD, MPH, attended medical school at the University of California San Francisco, and completed residency in internal medicine/ primary care at Brigham and Women’s Hospital (BWH). Following residency she lived and worked in Rwanda from 2011-2014, serving as a District Clinical Advisor for Partners in Health and then Deputy Director of Women’s Health, while pursuing a research fellowship in Global Women’s Health at BWH. In 2014, Dr. Pace became faculty in the Division of Women’s Health at BWH and an Instructor in Medicine at Harvard Medical School. In this faculty position she has continued to work with colleagues in Rwanda on breast cancer research, including studying diagnostic delays experienced by women, developing and evaluating an early detection training intervention, evaluating trainings for district hospital clinicians in breast ultrasound, and, now, assessing outcomes and quality of breast cancer care. Domestically her work focuses on the clinical impact of women’s health policies in the United States including family planning and breast cancer screening.
Project Title: Quality and effectiveness of breast cancer care at a Rwandan cancer facility
Burke Fellowship Research Abstract:
The incidence of breast cancer in low- and middle-income countries (LMICs) is rising, likely due to the population growth and aging, the decreased burden of infectious diseases, and shifts in breast cancer risk factors such as reproductive behaviors. Case fatality rates from breast cancer appear substantially higher in LMIC than in high-income countries, because of advanced-stage presentations and limited access to effective treatment. However, there are scarce data to guide implementation of effective, high-quality, and feasible breast cancer treatment programs in resource-limited settings. The goals of this project are to launch a rigorous assessment of breast cancer treatment and outcomes at the Butaro Cancer Center of Excellence (BCCOE), a rural public cancer center in Rwanda with a unique collaborative model of cancer care delivery. I will work with my research mentor Nancy Keating, and Rwandan colleagues, to build on our previous research at BCCOE and further support the center’s growth into a site for groundbreaking implementation research on cancer care delivery in LMIC.
Alexander Tsai, MD, PhD
Dr. Alexander Tsai is a board-certified psychiatrist at the Massachusetts General Hospital; Associate Director for Trainee Development in the Chester M. Pierce, MD Division of Global Psychiatry; and a faculty affiliate at the Harvard Center for Population and Development Studies. Through his research, he seeks to understand how large-scale social forces such as violence, stigma, and food and water insecurity conspire to undermine health and mental health among the poor and excluded. His principal research platform is a population-based social network cohort in rural Uganda. In 2011, Dr. Tsai received the American Psychiatric Association's Health Services Research Early Career Award, which is given annually to a single psychiatrist under the age of 40. Prior to his appointment at Mass General, he completed a Robert Wood Johnson Health and Society Scholars postdoctoral fellowship at Harvard University and his residency training in general adult psychiatry at the University of California at San Francisco. He currently serves as a pre-medical tutor for Harvard College undergraduates living in the Adams House residence.
Project Title: Water insecurity, child mental health, and HIV+ caregiver outcomes in rural Uganda: mixed-methods study
Burke Fellowship Research Abstract:
With increasing anthropogenic influences, global climate change has increased the frequency of precipitation & temperature extremes in East Africa. However, little to nothing is known about how water insecurity compromises health in vulnerable populations. Our preliminary qualitative findings from rural Uganda suggest that water insecurity is a critical household stressor that adversely affects household functioning as well as child and caregiver health and mental health. These data motivate my application to understand how water insecurity and family wellbeing are inextricably linked across generations, from children to caregivers. In collaboration with partners at the Mbarara University of Science and Technology in Mbarara, Uganda, I propose to use qualitative methods to develop and validate a parent-report measure of child mental health. In parallel, we will exploit a natural experiment to estimate the impact of a clean water intervention on adult mental health and household water insecurity. We will then leverage the infrastructure of an ongoing HIV cohort to test the extent to which child and caregiver mental health problems mediate the association between water insecurity, HIV treatment adherence, and engagement in HIV care. Until global climate change can be slowed or reversed, there will remain an urgent need for interventions to buffer vulnerable populations against its adverse effects. The data obtained through this study will inform the development of a parenting intervention aimed at Ugandan families struggling with food and water insecurity to help improve family functioning, family well being, and child development.
Bethany Hedt-Gauthier, PhD
Dr. Hedt-Gauthier serves as a member of the Global Health Research Core and a Research Advisor to Partners In Health/Rwanda. As a biostatistician, she is notable for her innovative application, development and evaluation of research and program monitoring and evaluation methodologies for the improvement of health of populations in resource-limited environments. In addition to providing technical support to research in Rwanda, Dr. Hedt-Gauthier also leads a variety of activities to build research capacity and teaches courses in biostatistics and quantitative research methods in Rwanda and at Harvard.
Burke Fellowship Research Abstract:
The research will thoroughly explore a set of operational research questions related to surgical care in rural Rwanda. The key questions include the following. With what medical conditions do patients present for surgical care in rural district hospitals and how are they treated? What are the outcomes of these surgical patients? What resources are available for surgical care in rural hospitals? What are the costs of these resources and how are they funded? All research will be developed as part of a training program to build local research capacity with three training modules: protocol development; data cleaning and analysis; and paper writing. Target trainees will be emerging Rwandan researchers interested in surgery and health care delivery and who can advocate nationally and globally for improved surgical services in rural settings in low income countries.
Ingrid T. Katz, MD, MHS
Dr. Katz obtained a BA from Amherst College, and a Master's in Health Science from Johns Hopkins Bloomberg School of Public Health before pursuing her degree in Medicine at University of California at San Francisco (graduating AOA). After completing her medical training in Internal Medicine and Infectious Diseases, she received a Global Women's Health Fellowship to study HPV vaccine uptake among adolescents in Soweto, South Africa. Her current research focuses on factors affecting refusal to participate in HIV treatment programs among HIV-infected, treatment eligible adults presenting for testing.
She has worked with multiple NGO's and multinational organizations, including the Population Council, UNICEF, and the World Health Organization. Dr. Katz has also served as an Editorial Fellow at the New England Journal of Medicine. She has been the recipient of the Harvard Catalyst KL2 Medical Research Investigator Training (MeRIT) Award, the Harvard Global Health Institute Travel Award, the Eleanor and Miles Shore Award, the CROI Young Investigator Award, the Center for AIDS Prevention Scholar Award, and a K23 Career Development Award.
Burke Fellowship Research Abstract:
As South Africa expands antiretroviral therapy (ART) eligibility to people living with human immunodeficiency virus (PLHIV) with higher CD4+ counts, it remains unclear if promoting earlier ART initiation will lead to widespread uptake to stop the spread of the HIV epidemic. We have identified treatment refusal as a critical barrier to ART initiation among asymptomatic PLWH who qualify for treatment. Our findings suggest that optimizing ART initiation for PLWH in South Africa will require an intervention to reduce individual barriers to starting ART, promote social support, and enhance linkages to the healthcare system. Our program, Unyango Iqabane (Treatment Partner), entails developing a peer-driven model of treatment initiation among PLWH in South Africa. We will build upon our prior research to develop an effective socio-behavioral multi-component peer intervention in partnership with researchers at The Desmond Tutu HIV Foundation, University of Cape Town, to ensure that HIV-infected South Africans who qualify for ART, initiate and sustain treatment. This research will inform and test a strategy to engage with treatment refusers about the benefits of early treatment, in order to achieve the goal of “Treatment as Prevention” in South Africa.
Rajesh Panjabi, MD, MPH
At age 9, Dr. Panjabi escaped a civil war in his home country of Liberia. He returned as a 24-year-old medical student to serve the people he had left behind, co- founding Last Mile Health, a Liberia and Boston-based non-profit organization working to save lives in the world’s most remote villages. Described by Forbes as “a healthcare model for 1 billion people”, Last Mile Health employs village health workers -- giving them the training, equipment, and support they need to perform as community health professionals. Their work has been published in the Lancet, the Journal of the American Medical Association, and PLoS Medicine and has been featured by the Wall Street Journal, NPR and the New York Times.
In 2015, Fortune Magazine named Dr. Panjabi one of the World’s 50 Greatest Leaders. Dr. Panjabi is a Forbes 400 Philanthropy Fellow, a Draper Richards Kaplan Foundation Social Entrepreneur, an Echoing Green Fellow and a Clinton Global Initiative Advisor. He is a recipient of the Outstanding Recent Alumni Award from Johns Hopkins, the Distinguished Young Alumni Award from the University of North Carolina, and the Global Citizen Movement Award. Dr. Panjabi received his medical and public health training at the University of North Carolina School of Medicine, Johns Hopkins Bloomberg School of Public Health, Massachusetts General Hospital and Harvard Medical School.
Burke Fellowship Research Abstract:
The 2014 Ebola epidemic in West Africa has spurred increased attention to the fragile mechanics of healthcare delivery in post-conflict states. The epidemic originated in remote rainforest region of rural Guinea, rapidly crossed into Liberia and Sierra Leone, and has since grown to become the largest Ebola outbreak in history. Persistent chains of transmission have been fueled by an overwhelmed and under-resourced healthcare infrastructure, and exacerbated by the loss of hundreds of health care workers in a setting where human resources for health were already severely limited.
In stark contrast to the current epidemic, all prior outbreaks in other low-income, sub-Saharan African countries have been controlled after a few weeks and, at most, hundreds of deaths. An important task for the public health community is to identify the features of the West African region that predisposed it to such a disastrous epidemic. While the exact mechanisms underlying the scope and tenacity of this outbreak are only beginning to be elucidated, the extreme fragility of the underlying health safety network in post-war Liberia – especially in remote rainforest areas -- is likely a major contributor.
Last Mile Health -- working with the Liberian Government, researchers at the BWH Division of Global Health Equity and HMS Department of Global Health and Social Medicine -- has developed a demographic and health survey to collect data on essential health indicators in remote rural villages of southeastern Liberian. The survey tool, to be administered on a yearly basis to yield a controlled before/after study design, will focus on maternal and child health indicators and help evaluate and inform community-based health services being deployed to help the health system recover from the Ebola epidemic. Specifically, we aim to inform the organization, local government, national government, and regional non-governmental organizations about the health priorities in the region and inform the Liberian Government’s $165M National Health Workforce Program. We also aim to evaluate our own programs by collecting annual data to measure changes in health indicators prior to and after initiation of targeted programmatic activities.
Pardis Sabeti, MD, DPhil
Dr. Sabeti is a computational geneticist with expertise developing algorithms to detect genetic signatures of adaption in humans and the microbial organisms that infect humans. Her lab’s key research areas include: developing analytical methods to detect and investigate evolution in the genomes of humans and other species; examining host and viral genetic factors driving disease susceptibility to the devastating and deadly diseases in West Africa, Ebola Virus Disease and Lassa hemorrhagic fever; investigating the genomes of microbes, including Lassa virus,Ebola virus, Plasmodium falciparum malaria, Vibrio cholera, and Mycobacterioum tuberculosis to help in the development of intervention strategies; determining the microbial cause of undiagnosed acute febrile illness.
Dr. Sabeti completed her undergraduate degree at MIT, her graduate work at Oxford University as a Rhodes Scholar, and her medical degree summa cum laude from Harvard Medical School as a Soros Fellow. Dr. Sabeti is a World Economic Forum (WEF) Young Global Leader and a National Geographic Emerging Explorer, and was named a TIME magazine ‘Person of the Year’ as one of the Ebola fighters. Her awards included the Smithsonian American Ingenuity Award for Natural Science, the Vilcek Prize for Creative Promise, the NIH Innovator Award, the Packard Fellowship, and an Ellis Island Medal of Honor. She has served on the MIT Board of Trustees and the National Academy of Sciences Committee on Women in Science, Medicine, and Engineering. Dr. Sabeti is also the lead singer and co-song writer of the rock band Thousand Days.
Burke Fellowship Research Abstract:
Chikungunya virus is the causative agent of a mosquito-borne disease characterized by fever and debilitating joint pain. Large-scale outbreaks of Chikungunya disease have occurred in Southeast Asia and East Africa; currently, Chikungunya virus has established itself in temperate urban regions of North and South America. Moreover, Chikungunya has spread to non-canonical mosquito species suggesting the occurrence of human-to- mosquito transmission and an increased epidemic potential.
Studying circulating strains is critical given the recent global spread of Chikungunya, mosquito host expansion, and wide-range of clinical outcomes. Viral genomic analysis may allow us to determine the variations that cause spread to different mosquito vectors and is pivotal to predict and control outbreaks. Furthermore, the genetic variation may also affect clinical symptoms and severity. Insights into the clinical profile of the genetic variation of Chikungunya will allow us to anticipate symptoms and target adequate therapies for patients.
Utilizing the significant investment in technological development for viral sequencing, the viral genomics group at the Broad Institute has sequenced and fully-assembled over 500 viral genomes from Lassa and Ebola clinical samples—including rapid response during the early stages of the 2014 outbreak in West Africa. This has significantly expanded the number of full-length sequences available and has allowed us to gain important new insights into the evolution and viral dynamics of these deadly viruses.
In collaboration with the University of Miami and the United States Army Medical Research Institute of Infectious Diseases (USAMRIID), we will conduct a pilot study to sequence Chikungunya genomes from a cohort of infected patients in Baranquilla, Colombia with varying symptoms. In our pilot study, acute Chikungunya clinical samples will be shipped to USAMRIID for initial processing—using methods developed in the Broad viral genomics group—then sent onto the Broad for sequencing and analysis. This information will provide the basis for 1) diagnosing disease severity in patients with Chikungunya-induced chronic arthritis and 2) understanding sequence variation within this geographical region.
Jennifer Scott, MD, MBA, MPH
Dr. Scott graduated from Middlebury College with a degree in Economics and from the University of Colorado School of Medicine with a combined MD/MBA degree. After completing a residency in Obstetrics and Gynecology at Beth Israel Deaconess Medical Center, she pursued a Global Women’s Health Fellowship at Brigham and Women’s Hospital and Master of Public Health degree from Harvard School of Public Health. In collaboration with academic partners, including Harvard Humanitarian Initiative, she has conducted research on gender-based violence and psychosocial consequences in humanitarian settings.
Burke Fellowship Research Abstract:
Sexual violence is prevalent in many conflict-affected countries in sub-Saharan Africa and survivors are at risk for psychosocial consequences, such as stigma. Stigma related to sexual violence may be a barrier to seeking health services and to seeking justice. Prior research conducted in Democratic Republic of Congo suggests that violence-related stigma is a mediating factor for mental health outcomes. However, instruments to assess sexual violence-related stigma are lacking and further research is needed to understand the relationship between sexual violence, stigma and mental health. Standardized assessments of sexual violence-related stigma could inform the design, implementation, and evaluation of programming and interventions. With support from the Burke Global Health Fellowship Program, research will be conducted to develop an instrument to assess sexual violence-related stigma.
Nava Ashraf, PhD
Dr. Nava Ashraf’s research combines psychology and economics, using both lab and field experiments to test insights from behavioral economics in the context of global development in Africa, Latin America, and Southeast Asia. She also conducts research on questions of intra-household decision making in the areas of finance and fertility. Her research is published in leading journals including the American Economic Review, the Quarterly Journal of Economics and the Journal of Economic Perspectives.
Dr. Ashraf has engaged in ongoing field experiments in Zambia, a nation with one of the highest rates of maternal deaths in the world, combined with an unmet need for family planning. Her research there focuses on the areas of health services delivery and educational investment. The Burke Fellowship allowed her to build upon her previous work in Zambia regarding a maternal mortality curriculum for men. The curriculum is based on the premises that while child-bearing imposes a large health cost on women, male partners do not always fully internalize this cost, both because it does not impact them directly, and because it is less salient to them. Dr. Ashraf and her team hypothesized that expanding men’s knowledge about the risks of childbearing for their wives can contribute to aligning the fertility preferences of men and women in households, and increase the use of family planning, ultimately decreasing maternal mortality rates. A pilot study showed promising results, with men’s support for family planning increasing fivefold after they receive education on maternal mortality with a voucher for family planning services, versus receiving a voucher for family planning services alone.
The combination of these results and Burke Funding led Dr. Ashraf to design and implement a randomized control trial to evaluate the impact of couples’ community workshops where the male or female partner is trained through a traditional family planning or a materiality mortality curriculum. The support of the Burke Fellowship also allowed Dr. Ashraf to hire and train field project staff to supervise the experiment.
The study is currently ongoing and the results will aid in assisting the Zambian Ministry of Health (MOH) and Ministry of Community Development, Mother and Child Health (MCDMCH) in implementing workshops nationwide to train community health assistants (CHAs), who are based in rural communities across Zambia to learn and teach the curriculum material to patients and community members.
Jessica Cohen, PhD
Dr. Jessica Cohen is a health and development economist with research that applies experimental and quasi-experimental methods to programs and policies affecting maternal and child health in sub-Saharan Africa and the United States. Dr. Cohen’s early work focused largely on randomized control trials (RCTs) related to appropriate treatment for malaria, technology adoption, messaging and behavior change, and pharmaceutical supply chains.
As a Burke Fellowship recipient in 2012, Dr. Cohen was able to broaden the scope of her research. She notes that the fellowship, “supported me in branching out to a new area of inquiry—maternal and neonatal health. [It] supported early qualitative and quantitative research to design two randomized trials in Nairobi, Kenya that apply behavioral economics principles to maternal and neonatal health.” The study aimed to understand how to help pregnant women to deliver their babies in high-quality facilities. Through qualitative interviews and basic surveys, Dr. Cohen and her team found that there is very little planning for delivery -- women haven't saved enough money, do not know much about the options for delivery facilities, and are uncertain about which facility they will choose for their deliveries. Thus, women arrive too late and/or choose to deliver in poor-quality facilities, resulting in lower maternal and child health outcomes.
With the early support of Burke funding, Dr. Cohen was able to secure a Gates Grand Challenges Explorations grant to co-fund the Nairobi project. She credits the Burke Fellowship with seeding the research that made her competitive enough to receive the Gates Grand Challenges award, allowing her “to explore methods to encourage women to utilize higher quality facilities for delivery and also to improve birth planning and safe, early arrival at delivery facilities.”
Dr. Cohen’s most recent work surrounds malaria and risk perception—specifically how people perceive the risk of contracting malaria for themselves and their children. She is working to develop sound, validated measures of risk perception, to integrate these measures into malaria transmission models and policy design, and to design an RCT testing the impact of more accurate malaria risk perceptions on malaria prevention and treatment behavior.
Dr. Cohen is Assistant Professor of Global Health at Harvard T.H. Chan School of Public Health and Affiliated Professor at the Jameel-Poverty Action Lab (J-PAL).
Jennifer Kasper, MD, MPH
Dr. Jennifer Kasper developed a passion for teaching during her pediatric chief residency at Boston City Hospital. Upon completing residency in 1996, she spent two years caring for pediatric patients and facilitating community health worker trainings with Doctors for Global Health in El Salvador. Since then she has developed curricula and delivered training for medical professionals in multiple underserved communities across the globe.
At Harvard Medical School (HMS), Dr. Kasper co-directs “Introduction to Social Medicine and Global Health.” This required course prepares first-year students to recognize and understand the social, economic, and political factors that affect patient health. Students explore the root causes of health disparities and the role that medical and public health interventions play in addressing them.
In 2012, Dr. Kasper successfully applied for a Burke Fellowship award to enrich and evaluate the HMS course. “The Burke Fellowship was fantastic because there are relatively few funding opportunities for faculty who want to pursue this kind of work as opposed to bench research,” she said.
Through her fellowship, Dr. Kasper developed new course content, identified resources to support student learning, and attended the Harvard Macy Institute’s Program for Educators in Health Professions. The Burke Fellowship also enabled her to design and implement a pre- and post-course knowledge assessment. Preliminary findings will be published this fall and suggest that the course deepens students’ understanding of the social determinants of health and equips them to conduct and use patient social histories. Dr. Kasper explained:
If you provide medication to a patient with diabetes but they don’t have access to food or live in a neighborhood where it’s safe to exercise, these factors will likely have a greater impact on their health than the clinic visit between you and the patient. It’s jarring for some students to hear this, so our course provides them with tools and examples they can use to promote patient health both within and outside of the clinical setting.
Dr. Kasper is a primary care pediatrician at Massachusetts General Hospital Chelsea Healthcare Center and a faculty member in the Global Health Division of Massachusetts General Hospital for Children. At HMS, she is an Instructor in Pediatrics and Chair of the Faculty Advisory Committee on Global Health.
Kasper J, Green JA, Farmer PE, Jones DS. All Health Is Global Health, All Medicine Is Social Medicine: Integrating the Social Sciences Into the Preclinical Curriculum. Acad Med. 2015 Dec 22.
Jane Kim, PhD, MSc
During her PhD program in health policy and decision sciences, Dr. Jane Kim traveled to Haiti to study cervical cancer prevention services at a rural clinic. Immediately, she was struck by the number of women who lined up outside the clinic daily to be screened and the opportunity this visit presented to provide them with other health services. Dr. Kim and her colleagues wanted to determine which additional services could be offered in conjunction with cervical cancer screening in order to maximize patient health gains. They used mathematical modeling and operations research methods to define an optimal package of services given patient health needs and the clinic’s budgetary and personnel constraints.
A few years later, Dr. Kim had the opportunity to build upon this work in South Africa. Looking at HPV vaccination programs for female adolescents, she wanted to design a framework that decision makers could use to identify the most cost-effective package of services to offer patients during vaccination appointments. Her goal was to enhance program leaders’ ability to consider costs, benefits, and non-budgetary constraints at the same time when deciding how to leverage patient visits.
The Burke Fellowship made it possible for Dr. Kim to develop models, collaborate with in-country partners around data collection, and train a Masters student in quantitative methods to support the project. The student, who has a strong interest in global health, is now pursuing a PhD in health policy at the Harvard T.H Chan School of Public Health. Dr. Kim is in the process of strengthening the dataset that will be used to run the models her team built.
“This award enabled me to reinforce collaborations with public health researchers, which has greatly enriched my professional network and shaped my research ideas,” Dr. Kim said. “Through these relationships, I have been exposed to the broader and complicated context of real-world obstacles that impede the successful provision of public health interventions otherwise found to be highly efficacious in controlled clinical trial settings.”
Dr. Kim is Associate Professor of Health Decision Science in the Department of Health Policy and Management at the Harvard T.H. Chan School of Public Health.
Danny Milner, MD, MSc
Dr. Danny Milner has been studying malaria and delivering pathology diagnostic services in Malawi since 2000. In 2012, he applied for a Burke Fellowship award to study how HIV infection affects the progression of cerebral malaria in pediatric patients. “We didn’t require very much funding, but we needed to be able to conduct a very specific set of experiments to understand the relationship,” he said. Dr. Milner partnered with the University of Malawi College of Medicine to study more than 3,000 cerebral malaria pediatric patients.
The Burke Fellowship provided Dr. Milner a unique opportunity to build upon his malaria research portfolio: “When you go to the NIH with a grant application for an area in which you haven’t published very much, it’s very difficult to get money. I had published extensively on cerebral malaria at that point but had very few publications on HIV. Having the opportunity to apply for a smaller grant on a more focused, experimental question was really helpful.” The Fellowship supported critical study components that would have been difficult to fund through other sources, including purchasing a flow cytometer and paying local team members to perform CD4 and viral load measurements.
Through his research, Dr. Milner discovered that children who die of “cerebral malaria” actually die of multiple causes, and HIV co-infection is one of them. Furthermore, HIV co-infection accelerates the progression of cerebral malaria, causing patients’ brains to swell more quickly than they would otherwise.
Dr. Milner’s findings have important implications for pediatric malaria screening and treatment. He has published three articles using data collected during the fellowship and is awaiting publication of a fourth article. He is planning a follow-up study to understand more precisely how HIV infection affects the spleens of cerebral malaria patients to advance the disease.
Dr. Milner is an Associate Professor in the Department of Immunology and Infectious Diseases at the Harvard School of Public Health. He is a Pathologist and the Assistant Medical Director of Microbiology at Brigham and Women’s Hospital, and an Associate Professor of Pathology at Harvard Medical School.
Hochman SE, Madaline TF, Wassmer SC, et al. Fatal Pediatric Cerebral Malaria Is Associated with Intravascular Monocytes and Platelets That Are Increased with HIV Coinfection. MBio. 2015;6(5):e01390-15.
Rebecca Weintraub, MD
Dr. Rebecca Weintraub has led the Global Health Delivery (GHD) Project at Harvard since 2007. GHD produces a variety of open-access courseware in global health, including Harvard Business School-style teaching case studies. Cases are designed to educate current and future managers on how governments and organizations strategize and design systems for health in resource-limited settings. A teaching note that guides instructors in preparing for and leading classroom discussion accompanies each case.
In 2012, Dr. Weintraub applied for a Burke Fellowship award to develop a case study on health care investments in rural Malawi. The case, Partners In Health in Neno District, Malawi, examines the relationship between investments in health infrastructure and economic development in Neno, as well as the decisions international partners made to improve and expand health services alongside the Malawian Ministry of Health.
The Burke Fellowship enabled Dr. Weintraub and her team to dedicate time and resources to researching and writing the case study and its teaching note. “It created intellectual space for me to concentrate on the research itself,” she said. Dr. Weintraub hopes the case will help students think about the complexities of leadership needed to scale and sustain a set of interventions as they become integrated into the local public health system.
Since publication in July 2013, Partners In Health in Neno District, Malawi has been taught at multiple graduate schools at Harvard and beyond. “We appreciate that the Burke Fellowship understands this is part of Harvard’s unique role as a global institution—to facilitate and speed the dissemination of public goods for global health,” Dr. Weintraub noted. “The Fellowship and university have been pivotal early investors, enabling us to attract other funding sources to build upon this work.”
Both the teaching case and its teaching note are available to download for free at www.ghdonline.org/cases, Harvard Business School Press, and The Case Centre.
Dr. Weintraub is Faculty Director of the Global Health Delivery Project at Harvard University. She is an Assistant Professor at Harvard Medical School and an Associate Physician at Brigham and Women’s Hospital, Division of Global Health Equity.
Joshua Salomon, PhD
Dr. Joshua Salomon’s research focuses on priority-setting in global health within the three main substantive areas: 1) measurement of population health status and health valuations; 2) modelling and forecasting health outcomes and disease burden; and 3) evaluation of the potential impact and cost-effectiveness of current and future health interventions.
As a Burke Fellow, Dr. Salomon pursued the overall goal of developing and applying a coherent framework for weighing health outcomes in summary health measures (such as disability-adjusted life-years) that are used as inputs to priority setting. His first objective included articulating a clear conceptual basis for assigning weights to health outcomes. The second involved applying this conceptual framework in empirical analysis of survey data collected in the Global Burden of Disease (GBD) 2010 project. The work was successful, leading to a new understanding of disability weights and revisions of the process, as well as a series of publications in the Lancet on the GBD 2010. It has also informed a revision of the full set of disability weights in the GBD 2013.
Dr. Salomon identifies the Burke Fellowship as “a pivot point” in his career. As a junior faculty member, it provided the intellectual support and space to do “rigorous academic research and produce something meaningful for the world.” The Fellowship was ideal preparation for Dr. Salomon’s tenure review, and he was promoted to Professor of Global Health at Harvard T.H. Chan School of Public Health in YEAR. He is also a core faculty member at the Center for Health Decision Science at the Chan School.
Daniel Shapiro, PhD
Dr. Shapiro’s research focuses on a critical aspect of global health: conflict resolution. Violent conflict threatens the physical and mental health of millions of people, and the resultant instability weakens healthcare systems, fosters refugee crises, and creates conditions rife for the spread of disease. Dr. Shapiro researches methods to address the emotional and identity-based roots of modern conflict, and his Burke Fellowship supported the creation of related undergraduate course materials that underpin his course, “Negotiation and Conflict Management: From the Interpersonal to the International” (Global Health and Health Policy 60).
Dr. Shapiro’s dynamic course examines the theory and practice of conflict resolution and has attracted broad interest from across Harvard College. In the course, students explore a new generation of research and practical tools aimed at addressing the rational and emotional dimensions of conflict. The investigation begins with a brief overview of traditional methods of negotiation, including interest-based negotiation. The students discuss the benefits and limitations of these methods. The discussion then moves to the emotional terrain of conflict. While emotions are commonly viewed as a “danger” to get rid of in a negotiation, the class explores how to generate positive emotions conducive to collaboration. Specifically, the students spend several classes examining five core emotional concerns that are important to all humans: appreciation, autonomy, affiliation, status, and role. The students reflect on how to address these concerns to stimulate positive emotions and collaboration. The conversation is informed by the rich literature on emotion theory, negotiation theory, and positive psychology. In the final leg of this course’s journey, the class explores the role of identity in conflict. How should negotiators address deep-rooted, identity-based divisions that can make conflict appear intractable? How should negotiators deal with value-based conflicts? The course surveys literature ranging from negotiation theory to identity theory, and by the conclusion of the course, students gain a much deeper understanding of the theory and practice of conflict management.
HGHI has continued to collaborate with Dr. Shapiro on the course and related learning opportunities for global health students. In his course, he draws on a variety of unique teaching methods, including case simulations, research projects, and the hosting of high-level guest speakers who share their own experiences in negotiating matters of serious global importance. Dr. Shapiro also regularly experiments with new teaching methodologies. For example, in an earlier iteration of Dr. Shapiro’s undergraduate course taught as a Freshman Seminar, he initiated a novel project in which students in the course engaged with world-renowned artist Romero Britto to translate key negotiation concepts into a series of original paintings. In April 2014, HGHI hosted a reunion event among Mr. Britto, Dr. Shapiro, and the former students, in a session open to all members of the Harvard community. In 2015, Romero Britto returns to the class to work with Shapiro’s students on a new set of paintings to depict methods for resolving identity-based differences.
Through this collaboration with Dr. Shapiro, HGHI has provided important pathways for students to engage in learning valuable theory and methods for resolving intractable conflicts and, ultimately, for improving the physical, mental, and social health of peoples across the world.
Kim Wilson, MD
Dr. Kim Wilson’s work focuses on improving health care for underserved populations both domestically and internationally. She combines clinical care to underserved families with implementation of programs aimed at improving care for children with chronic illness. Her involvement in global health care work developed through caring for a largely Dominican patient population in her clinical pediatric practice in Boston, and through conducting maternal, neonatal and quality improvement trainings in the Dominican Republic. The transnational nature of her patients awakened her interest in the “global is local, local is global” phenomenon, compelling her to refine her role in ensuring accessible, quality care for her patients.
As a medical educator, Dr. Wilson seeks to professionalize the practice of caring for underserved populations. This requires a unique skill set incorporating the social determinants of health, and an equity and advocacy agenda to reduce health disparities and influence policy decisions. The Burke Fellowship supported Dr. Wilson to focus on her own professional development in this area. During her fellowship year, she attending seminars centered on curriculum development and pedagogy at the Derek Bok Center for Teaching and Learning at Harvard, Harvard Medical School, and through the Boston Children’s Hospital professional development series.
Dr. Wilson’s focus on professional development has had large positive spillover effects, and her approach directly influences medical students, trainees and peers. She is the Fellowship Director for the Global Pediatrics Fellowship Program and Co-director of Advocacy Curriculum for Pediatric Interns at Boston Children's Hospital. She also serves as the lead specialist for the pediatric component of her work with the Human Resource for Health Program in Rwanda. At Harvard Medical School, Dr. Wilson is a regular tutor in the Essentials of the Profession course (formerly Introduction to Social Medicine and Global Health). She also teaches in Harvard Chan School’s Child and Society course, focusing on child health disparities in local and global settings.
Dr. Wilson is Assistant Professor of Pediatrics at Boston Children’s Hospital, and a practicing clinician at Martha Eliot Primary Care Center, serving largely underserved, minority and immigrant families.
Ingrid Bassett, MD, MPH
Dr. Ingrid Bassett is an infectious disease specialist who studies linkages and retention in HIV and TB care in South Africa. She first became interested in these areas when she was a research fellow in Durban studying patient responses to routine HIV testing. She and her colleagues found that while many patients were willing to be tested, a large proportion of those who were HIV-positive ultimately did not go on to initiate antiretroviral therapy (ART). Dr. Bassett wanted to understand what influenced people’s decisions to engage in care and to investigate options for increasing the likelihood that they would begin treatment.
When she applied for the Burke Fellowship, Dr. Bassett was on a NIH K23 award studying barriers to ART initiation in Durban. “I was at a transition in my career where I was working to move from a mentored career development award to a more independent NIH R01 award,” Dr. Bassett recalled. She used her Burke Fellowship funding to collect data through patient and provider interviews and to train and compensate local research staff. “The Burke Fellowship not only helped me advance the science of my research in terms of collecting the preliminary data I needed to receive and conduct a R01 study,” she said. “It also helped me build and maintain a strong research infrastructure in South Africa.”
Following her Burke Fellowship, Dr. Bassett received a NIH R01 award to conduct a randomized control trial of the relationship between case management and HIV care initiation and TB treatment completion. While she found that patients who worked with a “health system navigator” did not have better outcomes than patients in the control group, she observed that patients in the treatment group who spent more time with their navigators tended to have better outcomes than patients who had less contact with their navigators.
Currently, Dr. Basset is collaborating with a clinic in South Africa to test the impact of mobile HIV and TB screening. She and her team hope to increase the speed with which people are diagnosed so that they can begin treatment more quickly.
Dr. Bassett is an Infectious Disease Specialist at Massachusetts General Hospital and an Associate Professor of Medicine at Harvard Medical School.
Marcia Caldas de Castro, PhD
Dr. Marcia Caldas de Castro has been studying malaria since 1999. In 2004, she visited Tanzania to study malaria prevention and control efforts in the country’s largest city, Dar es Salaam, where nearly one-quarter of the population was infected. Local government leaders asked Dr. Castro to help them establish an Urban Malaria Control Program (UMCP) to reduce transmission and prevalence of the disease.
To identify the best environmental management strategies for prevention, Dr. Castro set out to better understand malaria transmission in Dar es Salaam. In addition to other data sources, she was interested in using satellite imagery to map potential mosquito breeding sites and at-risk populations. The Burke Fellowship was pivotal in allowing Dr. Castro to experiment with this unconventional, innovative methodology. “Seed funds like the Burke Fellowship provide the opportunity to think broadly, even if there’s a risk involved, and to accelerate the work you’re doing,” Dr. Castro said. “Usually large funders are reluctant to fund this kind of project.”
The Burke Fellowship enabled Dr. Castro to hire research staff to assemble the study’s large dataset. Although they were unable to use satellite data to predict malaria in Dar es Salaam, the images made it possible for them to identify and correct geographical location errors and to build special random samples.
Through the study, Dr. Castro demonstrated the importance of maintaining urban drainage systems and formulated policy recommendations for the UMCP. She trained local program leaders how to manage the program, and the local government established a budget for drainage maintenance. Malaria prevalence fell dramatically during the study and has remained low since Dar es Salaam launched the UMCP.
Since completing her fellowship, Dr. Castro has published multiple papers related to her work in Dar es Salaam and returned to the Amazon to continue studying malaria transmission and prevention. She teaches courses on demographic methods, spatial analysis, and public health field research at the Harvard T.H. Chan School of Public Health, where she is an Associate Professor of Demography in the Department of Global Health and Population.
Arachu Castro, PhD, MPH
Dr. Arachu Castro is a medical anthropologist whose primary interest is in understanding the barriers poor populations face in accessing life-saving health care. She has focused most of her teaching and research career on infectious disease and maternal health in Latin America and the Caribbean.
In 2007, Dr. Castro began working with UNICEF and UNAIDS to improve maternal and child health by integrating prenatal care with syphilis and HIV management. Dr. Castro helped seven Latin American countries conduct operational research and translate their findings to national strategies and pilot interventions. In 2009, Dr. Castro was looking for opportunities to build upon this work: “This was not hypothesis-driven research—the goal was to identify a public health problem and to change policy and medical practice. As a result, it was not a project that I could easily support through traditional funding sources. That’s when I came across the Burke Fellowship.”
The Fellowship enabled Dr. Castro to facilitate high-level meetings with country leaders to discuss research results, identify the changes needed to integrate care during pregnancy, and develop action plans. It also provided the support she needed to conduct fieldwork in Nicaragua and the Dominican Republic to pinpoint key barriers to and resources for integration. These and other participating countries have used their findings to change policy and create new partnerships to enhance linkages between prenatal care and sexually transmitted infection (STI) management.
Reflecting on her career, Dr. Castro said: “The Burke Fellowship gave me the opportunity to devote time to leading a large initiative that had a great impact. It gave me a lot of experience, as I was working directly with the AIDS and maternal and child health program directors in these countries.”
While at Harvard, Dr. Castro was an Associate Professor of Global Health and Social Medicine at Harvard Medical School and a Medical Anthropologist at Brigham and Women’s Hospital, Division of Global Health Equity. In 2012, Dr. Castro transitioned to the Tulane University School of Public Health and Tropical Medicine where she is the Samuel Z. Stone Chair of Public Health in Latin America in the Department of Global Health Systems and Development.
Ettenger A, Bärnighausen T, Castro A. Health insurance for the poor decreases access to HIV testing in antenatal care: evidence of an unintended effect of health insurance reform in Colombia. Health Policy Plan. 2014 May;29(3):352-8. doi: 10.1093/heapol/czt021.
Pérez-Then E, Miric M, Castro A. Facultad de Medicina de la Universidad de Integración de la Atención Prenatal con los Procesos de Detección y Manejo Clínico del VIH y de la Sífilis en la República Dominicana.Fondo de las Naciones Unidas para la Infancia, (UNICEF), 2011.
Hongtu Chen, PhD
Dr. Chen is a psychologist trained in mental health and health service research. His interest in geriatric mental health began in New York in the late 1990s, when he participated in a multi-site research project exploring care delivery for seniors with depression. Dr. Chen became interested in how services are delivered to elderly patients with dementia in Asian countries and applied for a Burke Fellowship award to conduct qualitative research in China and Thailand. “The Burke Fellowship presented an opportunity for me to focus on this specific research area,” Dr. Chen said.
The Burke Fellowship enabled Dr. Chen to interview patients, family caregivers, and program administrators in multiple cities across China and Thailand. Through these conversations he learned more about dementia care needs and resources in both countries and determined that there was a persistent need to improve quality of care, primarily through training. “In Thailand they have the human resources—this unique cadre of committed, trained community health workers—but not the information they need to improve their knowledge and skills,” Dr. Chen said. In light of his findings, he successfully applied for a Fulbright scholarship to develop culturally appropriate dementia care trainings for nurses and community health workers. “My confidence and interest in applying for a Fulbright were strengthened by the Burke Fellowship,” he reflected.
The work he accomplished through his fellowship also bolstered Dr. Chen’s confidence to apply for a R21 grant through the NIH’s Fogarty International Center. Using ethnographic research methods, he systematically assessed Thai elders’ health needs and found a significant gap in services and support. Dr. Chen hopes to use these data to inform future interventions and policy development and is working to conduct a similar study in China. In addition, he is interested in exploring the potential impacts of Thai massage and similar therapies on the health of patients with dementia. He is working with another researcher to design a pilot study that will explore the impacts of massage therapy on patients’ (1) agitation and anxiety, (2) depression, and (3) cognitive functioning.
Dr. Chen is Assistant Professor of Psychology in the Department of Psychiatry at Brigham and Women’s Hospital and Assistant Professor of Psychology in the Department of Global Health and Social Medicine at Harvard Medical School.
Manoj Duraisingh, PhD
Dr. Manoj Duraisingh is an infectious disease researcher with a specific focus on malaria. He and his research team at Harvard T.H. Chan School of Public Health are interested in understanding the processes that underlie the pathogenesis of human malarial disease at the cellular and molecular level using genetic approaches in the laboratory. They also conduct field projects with collaborators in malaria-endemic areas, including Senegal and India, to determine the relevance of their laboratory findings in different epidemiological settings.
As a Burke Global Health Fellow, Dr. Duraisingh’s award helped expand his research to question how red blood cell variations can influence malaria invasion and growth. This new direction was a close collaboration with investigators at the University of Cheikh Anta Diop in Dakar, Senegal. In the summer of 2011, Dr. Duraisingh mentored a student project to measure the variation in expression of human blood group proteins on the red blood cells from different individuals. This work seeded a much larger project in the lab which is now using global proteomic approaches to identify all the polymorphism that exists on the surface of red blood cells within this population, to identify ones that are determinants of malaria susceptibility.
Since receiving the Burke Fellowship as a junior faculty member, Dr. Duraisingh has been promoted to the position of John Laporte Given Professor of Immunology and Infectious Diseases at the Harvard Chan School.