Dec 6, 2023 | AIGH, Community, Diversity and Inclusion, Featured
Rachel Vreeman, MD, MS, speaks with Frank Anthony, MD, MPH, Minister of Health, Guyana (right)
The Icahn School of Medicine at Mount Sinai is seizing “an amazing opportunity” in global public health in a three-year initiative that is expanding health care to Guyana’s more than 800,000 citizens. Launched in 2022, the initiative is a partnership among Mount Sinai, the Hess Corporation, and the government of Guyana, and it is already bringing crucial health screenings to roughly half the nation’s eligible children.
“It is a profound honor to serve the people of Guyana in this mission to give everyone the best opportunity for a healthy and long life,” says Jeremy Boal, MD, Chief Clinical Officer of the Mount Sinai Health System, who is overseeing Mount Sinai’s efforts under the initiative.
Guyana is a racially and ethnically diverse nation at the northern edge of South America, with strong historic and cultural ties with nearby Caribbean nations. The nation entered a transformative era in 2015, when nearly 11 billion barrels of crude oil reserves were discovered offshore and its government began making plans to invest in much-needed infrastructure in many areas, including health care. Guyana’s National Healthcare Initiative was launched after John Hess, Chief Executive Officer of Hess and a member of Mount Sinai’s Boards of Trustees, approached Mount Sinai about partnering with Guyana’s government and Hess to expand health care in the country. The collaboration will make health care more accessible even to its most vulnerable citizens, including pregnant people and adults living with diabetes or cancer.
Working closely with Guyana’s government, a 40-member project team of experts from the Mount Sinai Health System are providing thought partnership to the country’s leadership to implement a range of improvements to the national health infrastructure of Guyana. These teams are led by the Mount Sinai’s Arnhold Institute of Global Health and Mount Sinai International, organizations dedicated to advancing Mount Sinai’s mission of delivering innovative, high-quality health care around the globe.
Initial steps: Increasing access to children’s health care, primary care for diabetics, and a “world class” pathology lab
Already underway is a national child and youth health initiative, the first primary care program for children in Guyana. Launched in August 2023, the program provides comprehensive health exams for all nursery school students in Guyana, children aged three to five years old. Within its first month the program conducted health screenings—including vision, hearing, and dental evaluation—on 50 percent of the eligible children in Guyana, and the program is now reaching every region of the country, including remote regions accessible only by boat or plane.
“We’re really proud to move this bold children’s health initiative forward with the Guyana Ministry of Health and Ministry of Education,” says Rachel Vreeman, MD, MS, Director of the Arnhold Institute for Global Health, which is guiding the program. “It provides the critical steps toward implementing a primary care system and more universal health coverage. We’re providing screenings that let us identify children’s health issues early and connect families and communities and schools with the health centers in a new way.”
Comprehensive school health screening in the indigenous community of Karasabai in Region 9, Guyana
The next step is to enhance the national primary care program for adults, which will initially focus on diabetes screenings. After developing new national guidelines on diabetes in partnership with Guyana’s Ministry of Health, Mount Sinai experts trained Guyanese health professionals to implement high quality screening and care for diabetes at every level of the health system. Under the program, which also supplies medication and equipment, the Guyanese providers will, in turn, travel across the country to train health professionals in their local communities.
“The diabetes care platform is a model for other ‘train the trainer’ programs and primary care efforts, which will expand to provide screening and care for health challenges across Guyana, including high blood pressure, cancer screening, mental health screening, and other chronic diseases,” Dr. Vreeman says. The diabetes training is accompanied by efforts to build an infrastructure of expertise, supplies, and referral pathways, explains Dr. Vreeman, noting that expanding primary care services throughout the country will prevent patients from having to travel long distances for care. The Arnhold Institute is also guiding the country in building a more robust health care workforce, as well as the eventual rollout of a national electronic health records system and national health information system strategy.
The health care initiative will also expand specialty and tertiary health care at both public and private health care facilities throughout the country, particularly in cancer and cardiovascular care. Under the partnership, Mount Sinai International is working with Guyana’s government to develop a strategic plan that will determine how and where these services will be implemented, and how they will be funded and staffed. While most of these services are still in the planning stages, a telepathology lab is expected to be in operation by January 2024. Using advanced remote technology, the lab will allow doctors in Georgetown, the nation’s capital, to work with Mount Sinai pathologists in New York to diagnose patients in Guyana.
“The technology will decrease the wait time in Guyana for high-quality pathology readings from two to three months to few days,” says Szabi Dorotovics, MD, MBA, President, Mount Sinai International, who is overseeing these efforts. “I don’t think I have to tell you how much of a difference that can make, especially in cancer care. The quality of the readings will be world class.”
Guiding quality improvements at Guyana’s largest hospital
Under the initiative, Mount Sinai is also consulting on quality and operational improvements with leaders from Georgetown Public Hospital Corporation in Georgetown, Guyana’s largest hospital, where roughly half of patients are women seeking maternity care. These include enhancements to its neonatal intensive care unit; accident and emergency services; fire and life safety procedures; information technology; pharmacy services; supplies, equipment, and technology; minor renovations to the hospital campus, and more. A major challenge faced by hospital leaders in rolling out these improvements is a lack of resources, including a shortage of nurses and equipment.
“What we have to do is work with them, given the constraints, and figure out what can we do,” says Art Gianelli, MBA, MPH, FACHE, Chief Transformation Officer for the Mount Sinai Health System, who is leading these efforts with the Mount Sinai International Group. “Maybe we can’t do what is ideal, but we can take practical steps to improve all of the areas.”
Most of these improvements involve process changes that make up the foundation of good care, explains Mr. Gianelli, some of which are already underway. “The next step is to build on this foundational work and start to drive changes in outcomes, but you have to start at the beginning.”
Hospital leaders have already made a number of quality improvements, such as installing soap dispensers throughout the building to help reduce the spread of hospital-acquired infections, and deploying hospital administrator “safety huddles” to improve awareness of potential safety issues. For Guyana’s largest and busiest hospital, where many patients travel long distances to obtain care, these changes are sure to have a positive “ripple effect” across the country, Mr. Gianelli says.
While Guyana’s health care initiative is still in its early phases, it is providing valuable insight into how to target, at a national level, social determinants of disease. This will allow the country to address problems early and provide community-based prevention strategies, according to Dr. Vreeman.
“Our teams feel really privileged to be serving as this partner for Guyana’s Ministry of Health,” says Dr. Vreeman, Chair of Global Health and Health System Design at the Icahn School of Medicine at Mount Sinai. “It’s an amazing opportunity to be able to bring up to scale some of the most evidence-based practices for what works in global settings. Through this initiative, Guyana is improving access to care, especially for marginalized and vulnerable children, and for people living in remote communities who have often experienced systemic inequities.”
Updated on Dec 8, 2023 | AIGH
Health challenges or inequities can be driving forces for change. This has led the NYC Partnership to award one-year pilot funds to address health challenges faced by communities receiving care in the public health care system in Queens, New York. This funding will enable teams at NYC Health + Hospitals (H+H)/Elmhurst, NYC Health + Hospitals/Queens and Mount Sinai to conduct collaborative research studies and care improvement projects that help address the communities’ health needs and affect change.
The NYC Partnership is a collaboration between the Arnhold Institute for Global Health at the Icahn School of Medicine at Mount Sinai, the Global Health Institute at NYC H+H/Elmhurst, and NYC H+H/Elmhurst and Queens.
The collaboration aims to engage in health care improvements, training, and research to address the needs of local Queens communities receiving care in the public health care system.
One mechanism to achieve this goal is the Pilot Project Awards, which encourage multidisciplinary and inter-institutional pilot projects. An 18-person Selection Committee composed of members from Mount Sinai, NYC H+H/Elmhurst and Queens reviewed and scored 19 applications, resulting in the funding of five projects for up to $25,000 each. The Committee selected these five projects:
Clinical and social implications that may exist by maintaining or removing race correction from pulmonary function testing in a racially diverse vulnerable population-Alfredo Astua, MD, and Ricardo Lopez, MD
There is a movement underway to remove race as a factor in many clinical algorithms as it can unfairly influence treatment options. Race correction equations used in pulmonary medicine may be preventing patients from receiving appropriate treatments as well as misclassifying the severity of disease. This project evaluates the effect of race correction, and its removal, from pulmonary function testing in the racially diverse communities served by NYC H+H/Elmhurst and Queens. Results will be correlated with social determinants of health and geospatial analysis of patients’ residence to understand associations of these social and structural factors on pulmonary diagnostics.
Alfredo Astua, MD
Ricardo Lopez, MD
Zachary L. Hickman, MD
NYC Health + Hospitals/Elmhurst Mild Traumatic Brain Injury and Concussion Program-Zachary L. Hickman, MD
As the only Level 1 trauma center in western Queens, NYC H+H/Elmhurst cares for approximately 800 patients with a traumatic brain injury (TBI) each year. The majority of these injuries are mild, including concussions. All patients with mild TBIs should be followed as outpatients by brain-injury specialists for the management of ongoing or prolonged symptoms related to their head trauma and for potential comorbid conditions (such as depression, anxiety, PTSD, or substance use disorders). If TBIs are untreated or under-treated, there are significant psychosocial and quality-of-life ramifications. Disparities in health care access and delivery are known to exist for patients after a TBI. This project will establish the first multidisciplinary Mild TBI/Concussion Program within the New York City public health system at NYC H+H/Elmhurst to reduce health care inequities in TBI diagnosis, treatment, and outcomes.
Perspectives of family caregivers and clinic staff on standardized caregiver needs assessment within an urban safety net primary care clinic for older adults-Harriet Mather, MD, MSc, and Hadeel Alkhairw, MD
Family caregiving is an urgent public health challenge due to the rapid increase in family caregivers and the impact on caregivers, care recipients, and the economy. Community-based caregiver support services are important for improving caregiver wellbeing, yet uptake of these services is low, with evidence of sociodemographic inequities. Systematic identification and needs assessment of family caregivers in primary care is a vital first step to promote uptake of support services. Through interviews with family caregivers of older adults attending the medical primary care clinic at NYC H+H/Elmhurst and focus groups with clinic staff, the study aims to understand the feasibility, acceptability, and preferences of caregiver needs assessment in primary care. This study will inform the co-design of a caregiver needs assessment and support intervention for family caregivers of older adults.
Harriet Mather, MD, MSc
Hadeel Alkhairw, MD
Ben McVane, MD
Assessing the Health Needs of Newly Arrived Immigrants and Asylum-Seekers in Queens-Ben McVane, MD
New York City has seen a recent significant increase in the arrival of asylum-seekers. This project will conduct a health-focused needs assessment using respondent-driven sampling of newly arrived immigrants and asylum-seekers in Queens. Data will be used to plan, fundraise, and advocate for a New Arrivals Clinic at NYC H+H/Elmhurst to better address medical and social needs. Participants with unmet needs will be connected to appropriate resources through community partnerships with Make the Road New York and the Libertas Center for Human Rights at NYC H+H/Elmhurst.
Cardiovascular Precision Medicine and Remote Intervention-Eyal Shemesh, MD, and Deborah Reynolds, MD
Non-adherence to medical recommendations for controlling high blood pressure and cholesterol is the leading cause for adverse outcomes in patients with cardiovascular morbidity. This project will use a cardiovascular variability marker, unstable and variable blood pressure readings, identified from electronic health records as a marker of non-adherence to flag patients at increased risk for poor outcomes. Cardiology clinic patients will be enrolled in a remote intervention for three months to increase engagement in care and improve adherence to medical recommendations.
Eyal Shemesh, MD
Deborah Reynolds, MD
Payal Ram is the Research Program Coordinator for the New York City Partnership at the Arnhold Institute for Global Health, and the Department of Global Health and Health System Design at the Icahn School of Medicine at Mount Sinai and the Global Health Institute at NYC Health + Hospitals/Elmhurst.
Oct 23, 2023 | AIGH
I arrived in Eldoret, “The City of Champions,” at the beginning of September 2023 to embark on a three-month research elective within the Academic Model Providing Access to Healthcare (AMPATH). As a fourth-year MD/MPH dual-degree student at the Icahn School of Medicine at Mount Sinai, I hoped this project would serve as a culmination of my previous coursework in global health, research methods, and preventive medicine, as well as a preview into what my future career could look like, which I hoped would include a strong research component to inform my clinical and public health responsibilities.
Kevin Griffee (he/him) is a Class of 2024 MD/MPH candidate at the Icahn School of Medicine at Mount Sinai
I first became interested in research and global health in college, where I worked on a wide range of projects, including those aimed at improving perinatal health among underserved patients in Washington, D.C.; preventing the spread of Lassa fever in Benin and Togo; and understanding the central auditory deficits associated with HIV infection in Dar es Salaam, Tanzania. I ultimately received a Certificate in Global Health upon graduating, along with a major in neuroscience and minors in biology and Chinese.
Following my medical school matriculation, I became increasingly interested in HIV. The COVID-19 pandemic served as a striking reminder that a parallel viral epidemic, more than four decades old, was continuing to infect more than one million people annually, including almost 500,000 young people. I wanted to understand exactly why this virus has persisted, despite the availability of antiretroviral therapy (ART) to prevent transmission and pre-exposure prophylaxis (PrEP) to prevent acquisition. The optimist in me even hoped we could make HIV obsolete in a generation, provided we maximize every tool in our HIV care and prevention toolbox.
One way to do this is through improving ART adherence. Adherence among youth populations tends to be lower than among other age demographics, which increases the risk for viral failure, drug resistance, and secondary HIV transmission. Our team was therefore interested in assessing novel approaches for improving ART adherence in this population, specifically digital health interventions, like mHealth and eHealth. We found mixed but promising evidence supporting the use of these interventions, especially text message-based ones. We hoped our findings would help guide future research and clinical decisions in this relatively nascent area of digitally supported HIV care.
Another HIV tool we have yet to fully maximize is PrEP. When used as prescribed, PrEP can reduce the risk of acquiring HIV by up to 99 percent. Unfortunately, PrEP use is plagued by disparities in access. In Kenya, for example, preliminary studies have suggested youth experience lower rates of PrEP uptake and adherence compared to older adults. The goal of our current study is to understand why this is the case, a particularly critical question given the large burden of HIV among youth in Kenya. By better understanding barriers to PrEP access, we hope to expand PrEP delivery programs in a way that best meets youth needs.
Key to this PrEP project, and other HIV-related projects that preceded it, is the participation of youth. Youth have generously shared their experiences, insights, and in some cases, their blood samples, for the benefit of research and future advances in HIV care. Another project I am working on is critically examining what youth, along with caregivers and subject matter experts, think about this research, and specifically the practice of biobanking for longitudinal clinical studies. We want to ensure that this research is done ethically, and part of this is confirming that the perspectives of youth and other stakeholders are reflected in current biobanking-related policies and procedures.
Together, these research projects address part three of AMPATH’s tripartite mission of care, training, and research. I also hope that the findings from our PrEP study will be used to improve PrEP service delivery at AMPATH-affiliated clinics and will therefore address part one of this mission as well. For part two, the training piece, I have enjoyed working with the incredible peer navigators at the Moi Teaching and Referral Hospital (MTRH) Rafiki Center of Excellence in Adolescent Health.
Members of the adolescent health research team. From left: Kevin Griffee, Ashley Chory, Josephine Aluoch, Eslyne Jepkemboi, Dennis Munyoro, and Tabitha Njoroge.
Peer navigators are members of the community who serve as links between patients and providers, and who offer counseling and other support services for youth living with HIV. Among their many responsibilities, peer navigators work to strengthen care engagement, improve medication adherence, and reduce HIV-related stigma. I have really enjoyed getting to know the peer navigators and helping them refine their project ideas for the Young Leaders Pilot Program, a joint initiative by Mount Sinai, Moi University, and MTRH to accelerate the development of adolescent health programs at Rafiki and AMPATH more generally. I have also enjoyed helping lead a workshop series with the peer navigators covering topics in research and professional development.
Outside of these activities, I have spent my free time in Eldoret engaging in AMPATH-sponsored lectures and discussions, exploring downtown and surrounding areas, sampling the delicious local cuisine, participating in pick-up soccer games, and taking regular Swahili and sewing lessons.
Overall, I feel so privileged to stay in this beautiful place, honored to work with such wonderful mentors and collaborators, and grateful to be so kindly welcomed into this community. I am very much looking forward to the remainder of my time here, strengthening the relationships I forged so far, and continuing to work together to make progress towards equitable, patient-centered access to effective HIV treatment and prevention methods worldwide. I would like to thank AMPATH, Moi University, MTRH, and Mount Sinai’s Arnhold Institute for Global Health for making this experience possible.
Kevin Griffee (he/him) is a Class of 2024 MD/MPH candidate at the Icahn School of Medicine at Mount Sinai
Updated on Sep 26, 2023 | AIGH
Jeb Weisman, PhD
Jeb Weisman, PhD, is Director of Global Health Informatics. He leads the Arnhold Institute for Global Health’s design and informatics initiatives, applying unique methods, tools, technologies, and multidisciplinary and interdisciplinary perspectives to complex global health challenges. His work centers on and supports novel applications of available technologies to address health information challenges and disparities on a global scale.
In this Q&A, he discusses his career journey and what inspired him to work in global health.
Can you tell us a little bit about yourself and your background?
I was born in the Canary Islands but grew up in the New York area. I’m happy to say I’ve lived and worked quite a few places around the world. I hold a doctorate in anthropology and have more than 35 years in health information systems. Though both anthropology and computer systems have been part of my life since the late 1960s, I’ve been an archaeologist, software developer, member of disaster response teams, textbook editor, and university faculty and CIO. I also worked once as a bouncer in Hawaii.
What inspired you to get into your career?
I’ve been inspired by the lives and philosophies of friends, colleagues, and human action through history. I prefer to do things that help people, through which I learn new things, and get to make a tangible difference. And I like to repurpose existing things—objects, ideas, approaches—to address existing needs. Still, I can’t say I’ve followed a career path in the traditional sense or even had a specific career in mind.
I decided at a very young age that I wanted to be an anthropologist, but less as a profession and more as an approach to understanding the world in which I was growing up. At the same time, I had a fascination for technologies that were maturing in the 1960s and 1970s, including computer programming. I learned to apply the ideas and practices embedded in my studies and interests to the occupations that presented themselves. Today I combine all the things I’ve studied and worked at into a useful and flexible skill set that serves the work I do every day.
What do you like most about working at the Institute?
The list is extensive, but here are a few. I like that my work and the work of my colleagues can have a direct and lasting impact on the quality of life of the people with whom we work, as well as the challenge of scaling this work. I like that I work with smart people who truly lead with a desire to make an enduring difference. And I like that working at the Institute forces me constantly to evaluate assumptions, and to adapt theory, knowledge, and skills to the work.
What led you to work in global health and what do you like about it?
I had done international work in disaster preparedness and response technology, archaeology, and cultural and forensic anthropology for a number of years before joining the Institute. So, the transition was fairly organic. All the pieces were in place waiting for the opportunity to present itself. As for why I like it, for the same reasons I like working at the Institute: enduring impact, smart people, scale, and constant challenges to my world view.
Can you tell us more about your research and how it has affected your work?
My work tends toward the applied, though sometimes it is in support of the academic research of others. One of the paths that led me here was translating social science to action. What we now call Translational Social Science (TSS). One of the best examples of TSS, for which I can take no credit, is Social Determinants of Health—which is now pervasive.
Combining TSS with informatics, I’ve developed and taught TSS courses, particularly in the context of digital health interventions. These interventions cover everything from EHRs and telehealth to all the devices we use to monitor our health and well-being. How do they shape us? What aren’t we seeing or misunderstanding when we use them? What are the unintended consequences and how do we think about and anticipate what we don’t yet understand? Social science, information systems and technology, and global health have come together in a way that lets me contribute to the global work that the Institute and Mount Sinai are doing in places such as Guyana and our other global partners, from Nepal to New York City.
What is some advice you would give someone looking to go into informatics?
Informatics is an enormous field with many, many sub-specialties, some very technical, others organizational, and still others process oriented. As you find the facet of informatics that most interests you and matches your skills, connect those skills with your unique life experience. Through this approach you can extend the value of your informatics work to the social, lived world. Hopefully, one result is that you create the basis for change and inspire new ideas and ways of doing things. And don’t worry if your path is not a straight line.
Sep 26, 2023 | AIGH
We are currently in the midst of a global crisis in child and adolescent mental health. The COVID-19 pandemic put a spotlight on the significant barriers youth and their families experience to accessing quality, evidence-based mental health care in all settings, including those that are otherwise considered to be resource-rich. In Kenya, the 2021 National Adolescent Mental Health Survey found that 12.2 percent of Kenyan adolescents (10-17 years) met criteria for a psychiatric disorder. However, of those, only 11.1 percent had accessed any form of support for their mental health concerns in the prior year, in part because of a lack of available services.
Mental health plays a critical role in the development and overall well-being of young people, which is why efforts are being undertaken at the MTRH-Rafiki Center for Excellence in Adolescent Health to improve the availability of mental health services for youth in western Kenya.
Florence Jaguga, MBChB, MMed, and Brittany McCoy, MD, are working together to lead progress towards the mental health-related care, research, and education priorities set out by the AMPATH Adolescent Working Group at the AMPATH Adolescent Summit earlier this year.
Brittany McCoy, MD
Dr. McCoy is the new Adolescent Mental Health Team Lead for AMPATH, a T32 Postdoctoral Research Fellow in Psychiatry, and an Instructor in the Departments of Psychiatry, and Global Health and Health System Design at the Icahn School of Medicine at Mount Sinai. She is a recent graduate of the Mount Sinai Triple Board Residency Program, where she trained in general pediatrics, general psychiatry, and child and adolescent psychiatry, and completed the requirements of both the pediatrics global health and global mental health residency tracks.
Dr. McCoy has a long history of engagement with AMPATH Kenya, starting in 2016 when she served for a year as the Indiana University School of Medicine Pediatric Global Health Research Scholar working with Rachel Vreeman, MD, MS. She has completed AMPATH clinical rotations at MTRH and continued to work with Dr. Vreeman and her team on research projects related to the mental health of youth living with HIV throughout her subsequent medical education and residency training.
More recently, she completed a study funded by an Pediatric Research Scholars Award at Icahn Mount Sinai to adapt a battery of mental health measures culturally and developmentally for Kenyan youth living with HIV. In her new position at AMPATH, Dr. McCoy hopes to use the unique skillset she has gained as a “Triple Boarder” to inform research, care, and education initiatives aimed at increasing adolescents’ access to evidence-based, culturally and developmentally appropriate mental health services in western Kenya.
Dr. Jaguga is a psychiatrist at MTRH and Head of the Alcohol and Drug Abuse Rehabilitation Services. She is co-chair of the AMPATH Adolescent Health Working Group. Dr. Jaguga has conducted research projects to evaluate the feasibility of a peer-led substance use screening and brief intervention program for youth at Rafiki. Her research findings support the feasibility of this program.
Florence Jaguga, MBChB, MMed
Dr. Jaguga has worked to integrate mental health and substance use screening for youth into the AMPATH electronic medical records system. The tools included in the screening are the Patient Health Questionnaire-9 (PHQ-9), the Generalized Anxiety Disorder-7 (GAD-7) scale, and the Substance Use Screening to Brief Intervention (S2BI) tool.
Next steps include training peer counselors to conduct screening for mental health using the tools. Youth screening positive will be referred to the psychologist that is currently stationed at Rafiki Clinic. Rafiki now also runs a weekly mental health clinic led by an MTRH psychiatrist, and youths who screen positive for a mental health concern will also be referred to this weekly clinic.
Over the coming months, Dr. Jaguga and Dr. McCoy will work together with others in the adolescent health and mental health initiatives at AMPATH to continue to grow the mental health services offered by the Rafiki Center and support adolescents’ mental health.
Sep 13, 2023 | AIGH
Hilda has served as a peer navigator at the MTRH-Rafiki Centre for Excellence in Adolescent Health at AMPATH for six years, working with pregnant and parenting adolescents.
Approximately 15 percent of Kenyan adolescent girls 15-19 years old have either had a live birth or are pregnant with their first child. Globally, evidence suggests an estimated 14 percent of adolescent girls and young women give birth before the age of 18. Across Kenya, many women deliver at home without skilled birth attendants, increasing their chances of birth trauma, hemorrhage, infection, and maternal or neonatal death.
Many adolescents lack supportive communities both throughout their pregnancy and after their child is born due to stigma associated with pre-marital sex and adolescent pregnancy. Findings demonstrate that fears of becoming pregnant are motivated by worries that their community will find out that they are sexually active.
Without supportive relationships in the home or community, adolescent girls in resource constrained and rural communities frequently face challenges in receiving basic pregnancy care.
In African countries, peer navigators have been shown to provide connective care for adolescent pregnant and parenting people. Adolescent peer navigators are young people who, through lived experience, are able to connect and collaborate with adolescent in need of care.
Peers serve as a necessary bridge between patients and clinical providers, often working to alleviate the stigma associated with their lived experience. Peer navigators work within clinic systems and in the community to increase patient care, engage them in needed services, support medication adherence, and provide social support, among others.
Hilda has served as a peer navigator at the MTRH-Rafiki Centre for Excellence in Adolescent Health at AMPATH for six years, working directly with pregnant and parenting adolescents. Hilda is studying counseling and psychology, and has a passion for developing mental health resources for this population. Hilda sat down with Ashley Chory, Global Youth Health Senior Program Manager, to discuss her passion for helping others and advocating for more resources for pregnant adolescents.
What does the day in the life of a peer navigator working with look like?
I have been working as a peer navigator at the Rafiki Center for six years. A peer navigator is someone who works as a link between adolescents and the clinical team. It really helps the adolescents because the peer navigators work as a liaison to eliminate barriers between them and the clinical providers. Often times, adolescents do not feel comfortable opening up to a nurse about certain topics.
As a pregnancy peer navigator, I do retention work, which entails taking the client documents, holding one-on-one sessions, conducting support groups, and following up on those who come to the clinic. When adolescent girls take a pregnancy test, if they are positive, the clinical team hands the pregnant adolescent to me. I advocate for pregnant teenagers’ rights, safety, access to care, and referrals. Immediately, they are transferred to the Maternal Child Health facility where they deliver. I also work with pregnant adolescents who are not doing well; there is a lot of stigma around adolescent pregnancy, which is seen as a consequence due to having sex before marriage. They do not have the support needed because society views pregnancy in adolescence as taboo. Sex is a taboo subject for young people; however the reality is that adolescents are engaging in sex. Because of this stigma around pregnancy, adolescents drop out of school, but they do not get the necessary financial and psychological support needed. I believe it is crucial to have adolescent peer navigators who have been through similar experiences to support them. They might even need a psychologist to step in and assist them through this difficult period.
How has being a peer navigator changed your life?
Being a peer navigator has significantly improved my self-esteem. Now I feel like I can contribute to society. I can connect adolescents to the services they require, which has enhanced my overall skills. As a psychologist, I used to be shy, but now I perform at a professional level. I can now speak to large crowds without feeling anxious.
What are some of the challenges young people who you work with face?
Adolescents need to have access to a social support program because it allows me, as a peer navigator, to understand what kind of advice I can give by learning from their lived experiences. There are general support groups for anyone who is HIV positive, but there is a need to have groups for pregnant girls only. The pregnant girls I work with lack financial assistance, and their mental health is a contributing factor. Pregnant girls also experience postpartum stress since they are unsure of what to do because they have dropped out of school, are unable to take care of themselves, and have been disowned by their parents. This is an extremely difficult time for these adolescent girls and I want to help them.
When you see a young child, there needs to be a visible connection between the parent and the child. The girls may not be properly taking care of the child because they did not realize the responsibilities were much more significant than expected. At the Rafiki Center, there are no longer services available to teach the girls what they need to know on becoming a parent. There used to a program which included support groups and chamas, but it stopped due to COVID-19. Some of the topics included parenting practices, self-care, mental health, empowerment after childbirth, and how to assist the child.
What motivates you as a peer navigator?
My motivation is helping adolescents. If the adolescents are happy, and I can see that I did something good, that greatly inspires me, regardless of my personal problems.
How would you describe yourself?
I am patient, a people’s person, and have the ability to be accommodative.
What do you want the world to know about young people and young people in Kenya?
I want the world to know that young people are unique. They must be heard, listened to, and given a safe space to express themselves without being judged.
If you had three wishes, what would they be?
I would like to earn a higher wage and become a well-known psychologist. I wish to create an entire center dedicated to assisting adolescents regardless of their HIV status. Finally, I want to highlight peer navigator programs because they play an important role in demonstrating that it is possible for adolescents to pursue a career in this field.
Sakshi Sawarkar, MPH is an Associate Researcher, Arnhold Institute for Global Health and Department of Global Health and Health System Design
Ashley Chory, MPH, is the Senior Program Manager, Global Adolescent Health at the Arnhold Institute for Global Health at Mount Sinai and the Department of Global Health and Health System Design.
