Updated on Sep 12, 2024 | AIGH
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.
Updated on Jun 27, 2024 | AIGH, Community, Featured
Since 2021, the Emergency Medicine Global Health Division at Mount Sinai has partnered with the Indian Health Service to provide physician and physician assistant staffing, operational assistance, and educational support at the Cheyenne River Health Center in Eagle Butte, South Dakota.
This remote, critical access hospital comprises an emergency department, a 10-bed inpatient unit, and community outpatient center. The Emergency Department serves about 30 patients daily from the local population on the Cheyenne River Sioux Reservation.
“The partnership has evolved from a few intermittent weeks of staffing to the point where we now expect to provide nearly 28 weeks of full-time attending physician staffing this year,” says John Rozehnal, MD, MS, Assistant Professor, Emergency Medicine, who leads the partnership with Indian Health Services.
John Rozehnal, MD, MS
Mount Sinai Emergency Medicine physicians and other health care providers who participate are given the opportunity to manage a wide range of emergency medical concerns and provide comprehensive critical intervention while developing knowledge of the indigenous culture to enhance their care. Other health care providers include physician assistants and residents, including four Emergency Medicine 2024 graduating residents who supported the partnership.
Recently, the team was successful in assisting with the implementation of a new point-of-care ultrasound (POCUS) equipment and programming, including training that has begun with an education project on the placement of ultrasound-guided IV lines, the performance of regional anesthesia, and the use of bedside diagnostic studies helping to assess pregnancies. Without these new services, patients would often require transfer to a hospital more than an hour away.
The growing partnership between Mount Sinai and Indian Health Services includes a variety of quality improvement projects, such as implementing clinical protocols and improving cultural competencies and quality and safety initiatives.
“We look to further integration with the local team at Eagle Butte and to help develop area-wide initiatives to further both teach and learn from the facilities and patients in the Great Plain Area,” says Dr. Rozehnal.
Updated on Mar 21, 2024 | AIGH
Ashley Chory, MPH, and Dennis Munyoro
The International AIDS Society (IAS) focuses on advancing HIV care and helping those living with or affected by HIV. The 12th biennial IAS Conference on HIV Science presented critical advances in basic, clinical, and operational HIV research that move science into policy and practice. The mission of the conference is centered around supporting polices of stigma reduction and to use evidence based data to inform attitudes, decisions and actions.
Dennis Munyoro is a peer researcher at the MTRH-Rafiki Centre for Excellence in Adolescent Health at AMPATH who was awarded a scholarship opportunity to attend the IAS conference in Brisbane, Australia. His work on engaging children and adolescents living with HIV and serving as a co-author on publications concerning adolescent stigma and ethics made him the perfect candidate to attend this conference. He became a peer navigator in 2016, and in 2021 transitioned to being a peer researcher after he aged out of the program. He discussed his experience at the conference with Ashley Chory, MPH, Global Youth Health Senior Program Manager, and Sakshi Sawarkar, MPH, Associate Researcher.
If you could describe your experience at the IAS conference in one word what would it be and why?
Amazing! Attending the conference opened my mind to new ideas in the field of HIV adolescent care. I was able to understand what the needs of adolescents are in different parts of the world compared to my country (Kenya) and what innovations could work best in my setting. For example, the use of technology to deliver information or linkage to care for people living with HIV.
What did you find to be the conference’s highlight?
The highlight of conference for me was a session titled “How to write a research manuscript: Publish or perish.” Since my interest is more focused on writing and publishing, this session was an eye opener for me as a young person venturing into the research world with the aim of finding solutions to gaps in care and treatment of HIV, especially for adolescents and young adults. Even though as young people we do so much in this area, we do not publish our work or findings.
What was your main takeaway from the conference?
I was very interested in the research aspect of the conference, particularly how to write a good abstract and proposal. This has been a significant help in advancing my career since it has provided me with valuable advice on how to draft strong proposals.
Did you meet other researchers who also work in the field of adolescents living with HIV? If so, could you share any insight into their findings that you found most fascinating? Were there any concepts you could apply into your own research?
Getting the story and telling it right is another area that fascinated me while interacting with the other researchers in the conference. There are a lot of untold stories that could give valuable lessons in terms of success stories or gaps, and if told right it could inform others on how to better implement programs in different dynamics and cultures. There was a concept of embracing and integration of eHealth in the care of HIV. I am more focused on adolescents and young adults, and the introduction and adoption of eHealth and social media platforms would be beneficial to this population since a significant number of them live in the digital world. If they get their information on the internet, it would be the right place to disseminate information to this population.
What was it like connecting with others who are just as passionate about helping adolescents living with HIV?
Attending the conference provided me with a unique opportunity to interact with various young people from different countries and cultures just as passionate as I am in the fight against HIV. Exchanging information with others in this field gave me a good insight on trying out different approaches in delivering care, especially exploring the use of tele-medicine and social media to demystify misconceptions in the community, which will have a great impact in stigma reduction.
Were there any presentations that helped you expand your knowledge about HIV outside of the context of adolescents?
There was a presentation on opportunistic infections being underdiagnosed until it is too late, for instance tuberculosis. The introduction of regular screening in the care unit would change this which will help the client get treatment early enough to contain the infection before it’s too late.
Was there a specific poster, abstract, or study that had a significant impact on you?
Yes, there were a lot of interesting posters in the conference that were intriguing. But the one I found most interesting was a study conducted in the southern part of Africa, where the researchers set up safe-like centers to dispense medications for potentially life-threatening illnesses, such as AIDS. When a client registers, they are notified of the passcode for the safe box their medication is in, and it can be picked up any time. The purpose of adding these medications to this program was to avoid stigmatization in the community. I believe with the right approach in my community, this program would be of value, especially to stable adolescents attending school while living with HIV.
What kind of opportunities did you get from attending this conference?
I had the opportunity to meet with the International Conference on AIDS and Sexually Transmitted Infections in Africa (ICASA) organizers where I was able to secure an online scholarship to attend the conference in Zimbabwe in December 2023. Participating in the conference provided me with an opportunity to network with young people along with various organizations at the conference.
What was your favorite part of your trip outside of the conference?
I really enjoyed my interactions with different organizations in the expo booths. It was refreshing getting to know the different technologies organizations are using to provide better access to HIV management and care. Outside the conference, I enjoyed the environment in Brisbane, the people, food, and culture. The city is one of the best I have ever visited and it was a great experience overall.
Ashley Chory, MPH, is Senior Program Manager, Global Adolescent Health for the Kenya partnership at the Arnhold Institute for Global Health and for the Department of Global Health and Health System Design.
Sakshi Sawarkar, MPH, is an Associate Researcher, Arnhold Institute for Global Health and Department of Global Health and Health System Design
Updated on Mar 20, 2024 | AIGH
Doulas providing information about doula care at a National Council of Negro Women, Inc. (NCNW) Power of Pregnancy Event. Top row: Christine, left, and Sora. Bottom row, from left: Harriet, Denise, and Donna.
Have you heard about doulas? Wondering who doulas are and what they do?
Doulas are trained coaches who provide non-judgmental, educational, emotional, and physical support during pregnancy, labor and birth, and the postpartum period.
Traditional doulas can provide strategies for self-care during pregnancy and for post-natal healing. They can provide hands-on pain-management techniques (such as breathing, positioning, massage) during birth, and they can assist their clients with communicating their questions, preferences, and values to their health care team. They also assist with strategies for newborn sleeping, breastfeeding, and overall assistance with transitions into parenthood.
Community-based doulas go even further by providing support beyond pregnancy and postpartum care. They connect their clients with additional resources such as food, clothing, baby supplies, mental health services, legal and immigration services, and anything else they may need. These doulas are from the communities they serve. They speak the same languages, and share backgrounds with the clients they serve; this makes it easier for individuals to connect with and access culturally appropriate and culturally competent care.
“If a doula were a drug, it would be unethical not to use it.” – John Kennell, MD, noted pediatrician and researcher at Case Western Reserve University in Cleveland known for support of doulas
From 2011 to 2018, there has been an alarming rate of pregnancy-related death, which is eight times higher for Black women than white women, and the rate for Hispanic and Asian women is twice that for white women. Additionally, COVID-19 has worsened this crisis, with minority pregnant women becoming infected at a higher rate than white pregnant women and having higher rates of death from COVID-19.
Doula care can help mitigate these health inequalities. Research has shown that having a doula can improve a person’s birthing experience, and increase their ability to initiate and continue breastfeeding. Additionally, doula care can contribute to shortening the length of labor, reduce the need for epidural and analgesics, decrease the incidence of cesarean sections, and reduce the risk of postpartum depression.
The Arnhold Institute for Global Health NYC Partnership is excited to share its efforts to increase doula care through “Helping Promote Birth Equity through Community-Based Doula Care” or HoPE, which is a program that has been developed in partnership between Mount Sinai the Icahn School of Medicine at Mount Sinai, NYC Health + Hospitals, NYC Health, Ancient Song Doula Services, and Caribbean Women’s Health Association.
The HoPE program provides community-based doula care and support free of cost, to anyone who is pregnant, giving birth, or gave birth recently at either Elmhurst Hospital or Queens Hospital. HoPE is made possible by our generous funders which include Robin Hood and the New York Health Foundation.
You may have seen some of our HoPE doulas in the waiting rooms at Elmhurst or Queens hospital, at community baby showers, resources fairs, and other local events focused on maternal health, health education, and health equity.
On average HoPE doulas provide four to eight prenatal visits, are present during the entire duration of labor, and provide 8-18 postpartum visits up to one year after birth. HoPE doulas are from the Queens community and speak many languages including Spanish, Bangla, Urdu, Punjabi, Hindi, Nepali, Haitian Creole, and Twi. HoPE doulas are advocates for the patients they serve. To better serve our Queens community, the HoPE program is working towards providing further specialized doula care and support to birthing persons experiencing housing insecurity or homelessness as well as justice-involvement or incarceration. Our work with homeless individuals and incarcerated birthing people is made possible by our funder, The Leona M. & Harry B. Helmsley Charitable Trust.
If you are giving birth at Elmhurst Hospital or Queens Hospital and are interested in working with a HoPE doula, request doula services by speaking with your health care team at your next visit or by calling 646-619-6721 and requesting a referral to the HoPE Doula Program.
Kanwal Haq, MS, is the Program Manager 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.
Updated on Jan 25, 2024 | AIGH
From left to right, Florence Jaguga, Ashley Chory, Ken, Vallary, Josephine Aluoch, and Lonnie Embleton representing the Adolescent Health Initiative at the AMPATH Kenya Global Gathering.
Since 2015, Mount Sinai, through the Arnhold Institute for Global Health, has participated in the Academic Model Providing Access to Healthcare (AMPATH) Consortium, a collaboration between Moi Teaching and Referral Hospital and Moi University in Eldoret, Kenya, and a number of North American academic medical centers.
In 2019, Mount Sinai became the lead Institution for the AMPATH Adolescent Health Initiative, which is housed at the Rafiki Centre for Excellence in Adolescent Health. In this role, Mount Sinai is responsible for the strategic development and systems strengthening of the care, research, education and community advocacy programs focused on adolescents.
Lonnie Embleton, PhD, MPH
Starting with the Rafiki Centre for Excellence, efforts are ongoing to expand the existing infrastructure to provide comprehensive and integrated care to all adolescents free-of-charge, regardless of HIV, housing status, or other characteristics. Comprehensive and integrated youth-friendly services encompasses providing holistic care across clinical specialties, including primary care, infectious disease, sexual and reproductive health, nutrition, and psychiatry, among others. Through the establishment of the framework of these goals, Mount Sinai will advocate towards improving the lives of adolescents in Kenya.
Working groups at AMPATH have been a vital and unique resource for research collaboration and activity since the program’s inception. These multi-disciplinary-focused groups were created to provide a bridge between clinical care and research, and to foster collaboration, particularly between researchers across the AMPATH consortium.
Florence Jaguga, MBChB, MMed
In July 2023, Mount Sinai formally took leadership of and formalized the AMPATH Adolescent Health Working Group, which includes representation from clinicians, researchers, public health and policy experts, and youth across the partnerships. The groups’ leadership follows AMPATH’s counterpart model, and is chaired by Lonnie Embleton, PhD, MPH, Assistant Professor, and Florence Jaguga, MBChB, MMed, with Josephine Aluoch and Ashley Chory serving as secretaries. The group also includes peer-elected youth leaders, Vallary and Ken, who are responsible for providing feedback on program and research proposals, as well as other youth-specific contributions to the working group.
By centering on AMPATH’s tripartite mission of care, education, and research, Mount Sinai has shaped the working group’s strategic domains around similar principles. The overarching goal of the adolescent health initiative is to ensure healthy lives and promote well-being for all adolescents in Kenya centered on delivering high-quality and standardized adolescent youth-friendly services.
The working groups’ purpose is to provide a forum for discussion of adolescent health programs and to identify gaps in existing resources; discussions span the complex topics and needs of adolescents globally. Additionally, a comprehensive research program, the establishment of health professional training, and the creation of long-term funding options can all contribute to enhancing adolescent health. Our aim is to develop, implement, and evaluate a robust set of standards, policies, educational, research, and fundraising activities over 10 years.
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 Senior Program Manager, Global Adolescent Health for the Kenya partnership at the Arnhold Institute for Global Health and for the Department of Global Health and Health System Design.
Jan 15, 2024 | AIGH
Sangina Ranjit Malla, MD, left, and Bhawana Regmi, MSc
Sangina Ranjit Malla, MD, and Bhawana Regmi, MSc, trained and visited Mount Sinai through the Arnhold Institute for Global Health’s global health education program in September 2023 for one month.
Dr. Ranjit is an Associate Professor, Department of Anesthesiology and Critical Care, at Dhulikhel Hospital and Kathmandu University School of Medical Sciences in Nepal. Ms. Bhawana is a lecturer for the Department of Medical Surgical Nursing and Nurse Manager, Adult Intensive Care Unit and Surgical Intensive Care Unit, at Dhulikhel Hospital in Nepal. They work closely together in Nepal and are both very passionate about global health.
In this Q&A, they discuss what they hope to learn from their visit to Mount Sinai.
Can you both please tell us a little bit about yourself and your work?
Dr. Malla: I am an anesthesiologist, currently working in the operating room as well as the intensive care unit. I joined Dhulikhel Hospital in 2003 and since then, I am committed to the principle and objective of my Institute: “quality health care for the poor.” I completed my anesthesiology residency in 2008 in Nepal and, over the years, I have developed a special interest in critical care, cardiac anesthesia, trauma, and resuscitation. My team and I provide perioperative care for specialized surgeries like neurosurgery, gastrointestinal surgery, cardiothoracic and vascular surgery, trauma, obstetrics, and pediatrics. Since we are growing and have more specialized surgeries, procedures, and disease conditions, we are encountering more sick patients. This inspired me to learn more about critical care and bring programs that will help my patients to have better outcomes. I also teach students earning a Bachelor’s Degree in Medicine/Surgery (MBBS) and an MD in anesthesiology.
Ms. Bhawana: I have been working in the adult intensive care unit and surgical intensive care unit of Dhulikhel Hospital as a nurse manager since September 2018. I am basically responsible for the staff, patients, and students in the adult and surgical Intensive care unit. I have also worked as a lecturer in the department of medical surgical nursing since September 2015. I teach critical care nursing and adult nursing.
What do you both hope to learn from your time visiting Mount Sinai and the Institute?
Dr. Malla: I would like to learn about specific procedures used in intensive care, as that is rare and inaccessible to learn in Nepal. For example, I want to observe how slow real replacement therapy is performed in the ICU. Since stronger broad-spectrum antibiotics are often used in the ICU, I want to learn how antibiotic stewardship has been practiced in Mount Sinai. I would also like to develop a rapid response team/critical care outreach, so I would like to observe how it is done in Mount Sinai. In addition, I would like to learn more about overall treatment and how critical care pathways are followed in the ICU. These pathways could be guideline, protocol, or a specific care plan for a specific disease.
Ms. Bhawana: I would like to observe nursing care being provided to the critically ill patients and the use of nursing process. I am interested in the involvement of nurses in the planning, implementation and evaluation of patient care and the involvement of nurses in the doctor’s round. Also in the different protocols being used for patient management; infection prevention policies and protocols; different diagnostic and treatment modalities for patients admitted in ICUs; and simulation regarding critical care procedures for students.
How do you both think you can apply what you learn from the visit to your work in Nepal?
Dr. Malla: The skills, techniques, and approaches that I will observe at Mount Sinai, I shall apply them to my daily practice with the critically ill patients back home. In addition to changes in my own practice, I shall develop protocols and guidelines in my ICU so that my colleagues, students, and nurses will be able to follow a better critical care medicine. Also, I shall develop small critical care training packages for my nurses and residents so that ongoing teaching and learning activities will multiply and propagate the skills I have gained to better care for our critically ill patients.
Ms. Bhawana: I will incorporate the knowledge, skills, and approaches learned there for myself, my staff and student’s practice. We will focus on improving patient care by developing different standards for providing nursing care and on making policies and protocols regarding critical care. As nurses are the most important members in the critical care, their inclusion and visibility can be shown in patient care.
What do you both like about working in Nepal and in medicine?
Dr. Malla: I love my country and my people. This is the place where I can be myself and be happy for the rest of my life. We have the responsibility to make the country worth living. If we don’t do it, who else will? This is my home and I love working to make this home safe and beautiful. Since health and medicine is the basic need of any citizen, I feel proud to be working in this field. Medicine is a noble profession that involves life-saving care. Anesthesiology and critical care is all about acute care and life-saving care, and this is what makes me content.
Ms. Bhawana: Nepal is a beautiful paradise on earth. It has a variety of landscapes, cultures, traditions, and friendly people. The people here have greater health needs because of ignorance, poverty, and lifestyle. The health system is very expensive in Nepal, as most of the health expenditure is out of pocket. So working with and for our own people has always been a matter of pride. We have so many learning opportunities in medicine in Nepal. On my team, all my colleagues are motivated, hardworking, and dedicated to their work. So it has always been my pleasure to work with them.
What is some advice you would give to someone wanting to work in global health and medicine?
Dr. Malla: Every human being deserves optimum quality health care. By working in global health medicine, one can participate in this revolution of improving the health of people globally. One can find tremendous opportunities for research and innovations that involves quality and equity in health care. Working in global health and medicine will definitely keep you proud and gratified.
Ms. Bhawana: Global health facilitates a broader understanding of global health challenges that rise above international borders. So the people who want to work in global health and medicine should not be restricted by society, economic, geopolitical, or security implications. Health care should be affordable and accessible for all.
Ashante R. Patterson is the Communications and Marketing Manager at Arnhold Institute for Global Health and the Department of Global Health and Health System Design at Mount Sinai.
