Rachel Vreeman, MD, MS, with the leadership of the Rafiki Centre of Excellence in Adolescent Health in Eldoret, Kenya.

Today, I’m writing with a heavy heart. Several of you have encouraged me to share directly about how current events are impacting our global health work, and I want to explain what that looks like.

Who I Am and What I Do

While it is my privilege to lead the Department of Global Health at Mount Sinai, I’m also a pediatrician specializing in global HIV care. I’ve spent the last 20 years working to improve care for children living with HIV.

• I’ve had the difficult job of delivering the news to countless families that their children have HIV, and I’ve witnessed too many lives lost.
• Most of my work has centered in the AMPATH Kenya partnership, where Mount Sinai partners with a Kenyan medical school and hospital system and the Kenya Ministry of Health.
• Together, we built an HIV care system that serves over 200,000 people at 300 clinics across Kenya.
• This system was initially made possible through USAID funding.

Dr. Vreeman on the pediatric ward of Moi Teaching and Referral Hospital in Eldoret, Kenya, in 2004.

The Miracles We’ve Seen

Until January, this system allowed us to witness miracles every day. When I first started, I saw mostly babies in HIV clinics because children with HIV typically didn’t survive past age 3 or 4 without treatment.

• Today, our clinics are full of adolescents and young adults who have grown up with HIV treatment.
• These young people are now heading to college, starting careers, and building families of their own.

One of the girls I’ve cared for over 20 years is now a nurse in our largest HIV clinic. I could share thousands of success stories like these, all of which bring me immense joy and pride.

The Impact of the USAID Funding Freeze

However, since January, everything changed.

• The freeze on USAID funding has shut down most of the health care system.
• We cannot continue to give life-saving medication.
• My WhatsApp is flooded with messages from young adults in Kenya who are now asking, “How will we have a future without our medications? Where is our hope?”

These messages break my heart, and I’m struggling to provide answers.

The Urgent Need

We’ve been working closely with the Kenyan government to find ways to sustain care, but having this system dismantled overnight is a nightmare.

• We estimate there is a $5 million gap to sustain the most critical health care services over the next year.

How You Can Help

I know this is a lot to ask, but if you are able to contribute anything at all to our emergency fund, it would mean the world to me – and to the thousands of lives we are trying to save.

• Donations can be made through the emergency fund set up at the Arnhold Institute for Global Health at Mount Sinai here.

Thank you so much for considering this urgent request. Your support can make a tremendous difference.

Rachel Vreeman, MD, MS, is a pediatrician, Chair of the Department of Global Health, and Director of the Arnhold Institute for Global Health at the Icahn School of Medicine at Mount Sinai.

Physicians at Dhulikhel Hospital in Nepal receive simulation training in newborn resuscitation.

The Arnhold Institute for Global Health at Mount Sinai has announced that the Laerdal Foundation has awarded $49,800 to support the launch of INSPIRE-Nepal. This initiative, which stands for Increasing Neonatal Survival Program Incorporating Reinforced Education and Distance-learning, will enhance neonatal resuscitation training for health care providers in Nepal, with a focus on rural and remote areas.

With the support of the Laerdal Foundation, the INSPIRE-Nepal initiative represents a vital step toward reducing neonatal deaths and improving outcomes in Nepal.

A Global Health Challenge

Neonatal mortality rates (newborn deaths) remain alarmingly high in Nepal, especially in remote regions. The Helping Babies Breathe program, an evidence-based training that teaches skills in resuscitating newborns who don’t breathe on their own after birth, has proven to decrease neonatal deaths globally. However, a critical challenge remains: Health care providers’ skills in neonatal resuscitation begin to decline within seven months after their initial training. This skills loss poses a significant barrier to sustaining improvements in neonatal outcomes, particularly in areas with limited access to continuing education.

Dhulikhel Hospital in Nepal and its 18 outreach centers handle more than 3,500 deliveries every year. However, there is no regular training program for neonatal resuscitation. This gap leaves providers without the support they need to retain their life-saving skills.

A Collaborative Solution

Our INSPIRE-Nepal project seeks to address this gap by combining in-person training, system strengthening, and distance-learning to create a sustainable solution that will continually reinforce neonatal resuscitation skills. Our project has three goals:

• Enhance Provider Knowledge, Skills, and Attitudes: INSPIRE-Nepal will provide health care workers with neonatal resuscitation training, systemize post-resuscitation screening and referrals, and assess facility readiness at Dhulikhel Hospital and its outreach centers.
• Provide Virtual Training to Sustain Learning Through Project ECHO: Using the Extension for Community Healthcare Outcomes model (Project ECHO), a telementoring and education program, health care providers will receive monthly, case-based sessions to reinforce their neonatal resuscitation skills. This approach will evaluate the retention of provider knowledge, skills, and attitudes 12 months post-training.
• Reduce Neonatal Mortality and Stillbirth Rates: By combining education with ongoing support, we aim to reduce stillbirths and the rates of newborn deaths on the first day of life, creating a model that can be used in other low-resource settings.

Why It Matters

Remote areas often face both high neonatal death rates and limited access to training and resources. We offer a practical solution by providing continuous training through Project ECHO to maintain skills and improve neonatal care. Our project offers a scalable and sustainable solution to mitigate loss of skills, ensuring providers are equipped to deliver high-quality neonatal care when it matters most. With the support of the Laerdal Foundation, we can transform care for the most vulnerable newborns.

Led by Rose House, MD, the INSPIRE-Nepal team includes John Kulesa, MD, Neha Limaye, MD, Diana Lee, MD, and Katherine Anderson, MD, from Mount Sinai; and Srijana Dongol, MD, and Anamika Mahato, MD, from Dhulikhel Hospital.

Established in 2022, AMPATH Nepal is a global health partnership led by Mount Sinai, Dhulikhel Hospital, and Kathmandu University School of Medical Sciences in Nepal.

Rose House, MD, MS
AMPATH Nepal Partnership Director
Associate Professor, Arnhold Institute for Global Health
Department of Global Health and Health System Design
Icahn School of Medicine at Mount Sinai

Since 2021, a global-local collaboration between Mount Sinai and NYC Health + Hospitals called the NYC Partnership has funded pilot projects that address health inequities faced by communities in Queens. These Pilot Project Awards encourage investigators at Mount Sinai, NYC Health + Hospitals/Elmhurst, and NYC Health + Hospitals/Queens to collaboratively consider health challenges and design research investigations, care interventions, and/or trainings to address them.

The collaborative nature of these awards has benefited previous recipients. Eyal Shemesh, MD, a 2023 awardee investigating a cardiology care engagement intervention, noted, “The grant was instrumental in allowing us to set-up and maintain a new and successful research partnership between the two institutions, a relationship that will now not be limited to the specific project related to the grant but, rather, will move forward with other initiatives.” Dr. Shemesh is a Professor of Pediatrics, and Psychiatry at the Icahn School of Medicine at Mount Sinai and directs the behavioral precision medicine program at The Mindich Child Health and Development Institute.

The community benefits as well. Deborah Reynolds, MD, Co-Principal Investigator with Dr. Shemesh, noted, “Our patients were absolutely thrilled with the project.  According to their own testimonies, it made them feel like they are participating in a community effort to help our providers learn how best to improve support—not just for the participants, but for others who receive care at the cardiology clinic.” Dr. Reynolds is an Assistant Professor, Medicine (Cardiology) at the Icahn School of Medicine at Mount Sinai.

This is the spirt of these awards. The NYC Partnership aims to continue to meet the needs of these communities through these awards and is pleased to announce the recipients of the 2024 NYC Partnership Pilot Project Awards. A 23-member Selection Committee conducted an NIH-style review of 20 applications. The Committee selected five projects for funding of up to $25,000.

Improving Inpatient Care for the Transgender Population in Queens, NYC: Joan Curcio-Williams, MD, Jessica Lichter, MD, and Guangdong Liu, MD

Transgender people experience significant health disparities and often receive substandard care. Many clinicians have not been trained to provide evidence-based, culturally competent care for this population, and operate in health care systems designed from a cisgender framework. There have been interventions to better address the health needs of transgender patients in the outpatient setting, but few have focused on inpatient hospitalizations. To address this gap, this project at NYC Health + Hospitals/Elmhurst aims to educate clinicians on providing optimal care for transgender patients in the inpatient setting and develop guidelines that safeguard the needs and dignity of this vulnerable population during acute hospitalizations.

Characterizing Children in Street Situations in New York City: A Mixed Methods Study: Lonnie Embleton, PhD, MPH

New York City’s migrant crisis has resulted in children in street situations selling candy and other items in the subway and begging on the streets with their families. Children in street situations rely on the street to live and/or work by themselves or with friends or family. These children often face social, health, and economic disparities and human rights violations. Their presence in NYC requires attention and interventions to ensure their well-being. This necessitates accurate data on these children’s social, economic, and health circumstances. This project will characterize the circumstances of children in street situations aged 5 to 17 years through a field-based survey of these children; a cross-sectional survey of a sample of these children, who will also receive a well child checkup at NYC Health + Hospitals/Elmhurst and be enrolled in NYC Care or Child Health Plus; and in-depth interviews with a sample of parents of these children.

Impact of a Virtual Healthy Lifestyle Intervention for Children and Adolescents with Obesity: Joan Han, MD and Thaina Rousseau-Pierre, DO, MS

In the United States, pediatric obesity affects 20 percent of children and adolescents, with higher rates among Hispanic and Black youth. The 2023 American Academy of Pediatrics (AAP) guidelines for childhood obesity treatment recommend intensive health behavior and lifestyle treatment (IHBLT) to improve nutrition and physical activity habits. Virtual IHBLT programs reach a larger population than in-person programs, but efficacy data are lacking and needed. Since 2021, the Pediatric and Adolescent Clinics at NYC Health + Hospitals/Elmhurst have been piloting a virtual 18-week IHBLT program developed and led by Larissa Polanco, MD, that meets AAP standards for patients age 8-17 years. This project will assess the impact of this program on physical and mental health outcomes and aims to improve the program through surveys, focus groups, and semi-structured interviews of past participants. Based on these data, the IHBLT program will be expanded to the Healthy Lifestyle Clinic for pediatric obesity treatment at  Mount Sinai Hospital.

Assessing Barriers to Health Care and Enhancing Health Care Access for Latinx Immigrant Workers: Homero Harari, ScD, Adina Valceanu, MD, and Laura Sirbu, MD

Nearly 75 percent of Latinx immigrants in New York City work in occupations that deem them “essential workers,” however these jobs can put them at higher risk for occupational injury. Many of these workers do not receive health insurance or paid sick leave and are unaware how to address their injuries and health needs. Through a collaboration between the Mount Sinai Selikoff Centers for Occupational Health (SCOH) and NYC Health + Hospitals (H+H)/Queens, this project aims to assess this gap in care through focus groups of workers, semi-structured interviews with SCOH and NYC H+H/Queens employees and key community stakeholders, and a survey of workers from different occupational sectors. Based on these results, a referral system between NYC H+H/Queens and SCOH will be created to address the occupational injuries of this population, with the goal to expand this pilot project to all ambulatory NYC H+H sites.

Digital Inclusion and Risk Communication to Improve Blood Pressure Control in the Emergency Department (ED) (INCLUD-ED): Phase 1 Planning: Kimberly Souffront, PhD, RN, FNP-BC, FAAN

Elevated blood pressure detected during an emergency department (ED) visit can be a predictor of chronic uncontrolled hypertension. There is variability in hypertension management in the ED. This project will develop a novel intervention that will use electronic health records to identify patients in the ED at NYC Health + Hospitals/Elmhurst with sustained asymptomatic hypertension and provide them a tailored risk communication intervention led by an ED nurse. These patients will be referred to a digitally inclusive remote patient monitoring program that does not require Wi-Fi and is supported by clinical pharmacists for up to 12 months, regardless of insurance status, to further manage their hypertension.

The NYC Partnership congratulates the award recipients and looks forward to working with them to address the needs of communities in Queens.

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 Health + Hospitals/Elmhurst, NYC Health + Hospitals/Elmhurst and NYC Health + Hospitals/Queens. The NYC Partnership Pilot grant program aims to stimulate innovative, collaborative, and multidisciplinary projects to improve the health of our community.

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.

Building off our inaugural summit in January 2023, the Mount Sinai Adolescent Health Team gathered in Eldoret, Kenya, to host the second AMPATH-Kenya Adolescent Health Summit.

More than 200 participants attended the three-day event, where adolescent health care specialists, researchers, government officials, peer navigators, and health-minded youth gathered to learn, share, and connect with colleagues in the field. Activities included educational sessions, workshops, interactive roleplay, and strategic planning for the coming year. The event was held Monday, June 17, to Wednesday, June 19.

Faculty from the Arnhold Institute for Global Health at Mount Sinai, as well as Moi Teaching and Referral Hospital, kicked off the summit with presentations on the state of adolescent health at AMPATH across the domains of reproductive health and mental health, among others.

Salim Bakari, a founding youth peer mentor in the AMPATH program in western Kenya and senior researcher in the AMPATH pediatrics program, led a youth panel discussion focused on the theme of innovations in adolescent health across AMPATH

Lonnie Embleton, PhD, Co-Chair of the AMPATH Adolescent Health Working Group (AHWG) and an Assistant Professor in the Department of Global Health and Health Systems Design at the Icahn School of Medicine at Mount Sinai, presented on the state of adolescent- and youth-friendly health services in Uasin Gishu County. Salim Bakari, a founding youth peer mentor in the AMPATH program in western Kenya and senior researcher in the AMPATH pediatrics program, led a youth panel discussion focused on the theme of innovations in adolescent health across AMPATH.

Day one concluded by highlighting AMPATH innovations in adolescent health, including projects led by Edith Apondi, MBChB, Mmed, who is the Consultant Pediatrician and founder of the Rafiki Centre of Excellence in Adolescent Health at MTRH and works with the Kenyan Adolescent HIV Implementation Sciences Alliance (KAHISA), and Florence Jaguga, MBChB, Mmed, who is the Consultant Psychiatrist at MTRH and works on screening and brief interventions for youth substance use disorders.

The second day of the summit focused on education. It began with a keynote address from Sabrina Kitaka, MD, PhD, founding president of the Society of Adolescent Health in Uganda and Senior Lecturer and Adolescent Health Specialist at Makerere University, who discussed founding adolescent health in Uganda. Then, faculty and youth awardees of the 2024 Mount Sinai RFA presented on their planned work. In the afternoon, summit participants split up to attend small-group education sessions. Topics included adolescent contraception, mental health, structural and social determinants of health, adolescent development, transitions from pediatric to adult care, and engaging youth as meaningful partners in research.

Day three of the summit began with a keynote address from Mary Ott, MD, MA, Professor of Global Health and Pediatrics and Associate Director for Youth Health Programs at the Arnhold Institute for Global Health. Dr. Ott spoke on Human Rights and Adolescent Health. Then, Dr. Ott moderated a panel of six adolescent health specialists discussing strategies for effectively communicating with young people.

Panelists included Dr. Apondi; John Steever, MD; East African specialist Njeri Karianjahi, MBChB, MmEd, consultant pediatrician at the University of Nairobi and Gertrude’s Children’s Hospital; Katherine MacDonald, MD, and Dr. Kitaka. After the panel, participants broke into small groups to practice, with youth participants playing the role of adolescents, and conference attendees practicing interview skills.

Rachel Vreeman, MD, MS, Chair and Professor in the Department of Global Health and Health System Design and Director of the Arnhold Institute for Global Health, facilitated an interview-based role play session

After the formal closing of the summit by Rachel Vreeman, MD, MS, Director of the Arnhold Institute for Global Health, and Dr. Apondi, AMPATH consortium members stayed after lunch for an afternoon of strategic planning for the coming year, across the domains of sexual and reproductive health, mental health, peers and youth participation, and adolescent and youth-friendly services and community advocacy.

After a long and productive week in Eldoret, attendees filled out a feedback form about the summit. More than 90 percent reported that the summit helped them develop new project ideas, presented knowledge relevant to their work, improved their knowledge and skills related to adolescent health, and facilitated collaboration with their colleagues in the field of adolescent health. We are so grateful for everyone’s participation and cannot wait until the next summit.

Ava Boal is an Associate Researcher at the Arnhold Institute for Global Health and the Department of Global Health and Health System Design.