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SEPTEMBER / OCTOBER 2004

BULLETIN

In this issue:

: Chance encounter presents HMI and WHARF with a new opportunity to enhance HIV/AIDS awareness in India
: Collaboration with university in Iraq is first project of new Center for Healthcare Planning and Quality
: Second Specialty Practi-Med to focus on musculoskeletal health concerns
: Novartis CME program on cardiology is a success—second event planned
: DHCC construction guided by novel review process
: Popular BeST Resident program gets rave reviews from surgical residents

Chance encounter presents HMI and WHARF with a new opportunity to enhance HIV/AIDS awareness in India

Dr. Lokendra Singh Rathore, secretary of Madhya Pradesh AIDS Control Society (MPSACS), Jhabua division, lectures during the WHARF workshop on HIV/AIDS at Jhabua’s district hospital.

On the front lines of the struggle against HIV/AIDS in India, health care workers are coming to grips with the realization that this epidemic is not just an urban phenomenon. Today rural villages far from cities like Mumbai, Chennai, and Kolkata are seeing the disease spread among a population that is already disadvantaged by poverty, illiteracy, and a lack of reliable health information. In July, the predominantly tribal district of Jhabua was the site of an education program aimed at providing nurses, midwives, teachers, and community leaders with the tools and knowledge to address the HIV/AIDS problem in the region.

Fabian Toegel

The program was spearheaded by Fabian Toegel, a medical student at Ludwig Maximilians University (LMU) in Munich who was part of a group of students doing clerkships in Harvard-affiliated hospitals. Toegel, who spent a year in India performing community service while a college student, is involved with a German NGO called API which attempts to bolster the quality of life of the Bhil population of the area. While in Boston, Toegel caught the attention of Dr. Harvey Makadon at HMI. Together, they worked with WHARF (Wockhardt-HMI HIV/AIDS Education and Research Foundation) to find a way for the Mumbai-based NGO to contribute to health care efforts in Jhabua.

The two-day program, which attracted a diverse group of 170 participants, was led by WHARF faculty members Dr. Deepak Batura and Rakhi Nair. Presentations by the program faculty on the transmission and prevention of HIV/AIDS elicited eager discussion by the participants, whose burden of responsibility in their communities is exacerbated by a lack of resources. The goal of the program was to increase HIV/AIDS awareness, educate the audience about preventive practices, and encourage healthy attitudes towards people living with HIV/AIDS in order to reduce discrimination and stigmatization.

“The program was well appreciated by the participants as well as the local organizers. The message was not lost on the headmen and teachers. Private discussions with them showed they had grasped the message as well as the rest of the participants,” said Batura, who added that headmen and teachers, while not providing care, wield considerable influence on local matters.

The program’s success can be credited, in part, to the synergies that have developed between several different organizations working in the region. The program was organized by ACSSS (Adivasi Chetna Shikshan Seva Samiti, or Tribal Awareness and Education Services Society), which is the Indian organization through which API operates in India. Madhya Pradesh AIDS Control Society (MPSACS) provided support as well. These groups, particularly ACSSS, have worked hard to earn the trust of the villagers, who have traditionally used superstition, not science, to explain illness. Jhabua, located in the western part of Madhya Pradesh (northeast of Mumbai), has a population over a million.

Toegel, who was in Boston finishing a hospital rotation when the program was held, said that WHARF’s involvement comes at a critical juncture when API and ACSSS are part of plans to develop five regional centers for HIV testing and counseling. “We hope that WHARF will be able to provide more workshops like this in the future. In the meantime, WHARF will use its experience in Mumbai to advise us on establishing our center,” said Toegel. API is currently working to raise funds in Germany to support WHARF’s ongoing involvement in Jhabua.

Makadon, who plans to join Toegel in Jhabua later this year to help plan future programs, said that the success of the Jhabua program demonstrates the potential impact that WHARF could have throughout India. He also emphasized that the WHARF faculty can play a crucial role as API and ACSSS develop a new testing and counseling center. “It will be important that they be prepared for what they will need to do to manage those tested and support both families and communities as individuals may discover that they are infected with HIV.”

Collaboration with university in Iraq is first project of new Center for Healthcare Planning and Quality
A partnership with the Tikrit University School of Medicine in Iraq will provide Dubai Healthcare City (DHCC) with a new opportunity to make good on its mission to raise the level of health care services in the Gulf Region. Through the newly launched Center for Healthcare Planning and Quality (CPQ), DHCC and HMI will assist with the development and re-establishment of the university, with a focus on helping the school implement the latest models of medical education and faculty development.

The CPQ is a joint initiative developed by the partners to enhance health systems development, medical education, and professional development throughout the Gulf Region. The CPQ’s services are based on the success of HMI’s programs and partnerships around the world, and have been designed to extend the advances made at DHCC to other health care organizations and academic institutions both within and outside Dubai.

“Tikrit is a site of great need in Iraq, and the region is fortunate to have a team of dedicated professionals who are focused on making the university a fully functioning entity of national and regional standing,” said Saeed Al Muntafiq, chairman of the board of DHCC. “This is the first initiative that the Center of Healthcare Planning and Quality is participating in and we hope that the CPQ will contribute effectively to improve the health systems and standards throughout the region.”

Al Muntafiq said that an agreement was made between the CPQ and the leadership of the Tikrit University after initial meetings in Dubai in June. “We had the opportunity to learn more about the critical needs of Iraq’s healthcare system, and further investigate how we could harness our resources in a collaborative effort,” he said. “The next step by the CPQ will be to assess the university’s current state, including the infrastructure, professional staff, and resources, and develop a comprehensive work plan for moving forward.” An HMI project team is now being assembled, and plans are underway for a one-day workshop that will be held in Dubai.

Dr. Robert K. Crone, president and CEO of HMI, said that the leadership of both HMI and DHCC were hopeful that through the CPQ, they could make important—and lasting—contributions to the development of a health care infrastructure in the region. “One of many pressing demands going forward for the people of Iraq is a sustainable healthcare system, and a medical education infrastructure that supports the development of the country’s human resources,” he said.

The city of Tikrit lies on the west bank of the Tigris River, north of Baghdad. Tikrit University is renowned in the region for its science and engineering programs, and the medical school already uses problem-based learning in its curriculum.

“This project is an example of the perseverance that characterizes health care efforts around the world, particularly those that are undertaken in difficult situations and against significant odds,” said Crone. “Healthcare has always been an area where barriers are set aside in favor of collaboration and knowledge exchange, and HMI is eager to take part in such an endeavor.”

Second Specialty Practi-Med to focus on musculoskeletal health concerns
Harvard Medical International and Dubai Healthcare City (DHCC) will present “Specialty Practi-Med Dubai: Musculoskeletal Health and Sports Medicine,” a medical education symposium aimed at developing practical solutions to address one of the Gulf Region’s most pressing health care challenges. A distinguished multidisciplinary faculty will present updated knowledge on a range of topics in this field.

The two-day program, which will take place September 28-29th at the Knowledge Village Conference Centre in Dubai, has been organized by HMI and DHCC.

Omar Moawiyah Al Shunnar of DHCC

“Around the world, health care leaders are encouraging people, both young and old, to be more active, as sedentary lifestyles are increasingly tied to chronic health problems like obesity, diabetes, and cardiovascular disease,” said Omar Moawiyah Al Shunnar of DHCC. “With this in mind, HMI and DHCC are contributing to this global effort with a program to support those health care providers whose treatment and advice helps to keep us active.”

This program is the third lifelong learning event presented by HMI and DHCC. The first, Practi-Med Dubai 2003, attracted more than 1,200 health care professionals to hear about advances in clinical practice. In May, around 100 health care professionals from the region gathered to hear the latest knowledge regarding the prevention, diagnosis, and treatment of diabetes. Feedback from both conferences has attested to the power of these continuing medical programs to have immediate impacts on daily practice.

The September program will address the full scope of musculoskeletal health issues: common problems such as osteoporosis, arthritis, and inflammatory joint disease; approaches to treatment, including rehabilitation and drug therapy; and the major issue stifling physical activity for many people, pain. The program faculty will educate and inform attendees through keynote lectures, workshops, and case presentations. Health care leaders in the UAE are eager to raise awareness of the threat posed by conditions like osteoporosis. In addition, Dubai’s continued growth as a regional center of tourism and recreation has placed a greater emphasis on sports medicine.

Dr. Charles H. Brown Jr.

“This program is exciting because it brings together a diversity of health care practitioners to discuss problems that cut across many aspects of our lives, from comfort in the workplace to the ability to enjoy our leisure time,” said Dr. Charles H. Brown Jr., a clinical instructor in surgery at Harvard Medical School who is the program’s course director. “One of the very unique aspects of Dubai Healthcare City in its design is the commitment to wellness programs and facilities, and providing services and education to enhance the quality of life for families. Our program in musculoskeletal health and sports medicine is a perfect compliment to those efforts.”

Brown added that musculoskeletal problems account for between 10 and 20 percent of the patients seeking medical treatment in the United Arab Emirates, and are among the most common reasons that patients in the UAE request out-of-country referrals.

This Specialty Practi-Med program has been designed for orthopedic surgeons, physiatrists, and physical therapists. Primary care physicians with an interest in treating musculoskeletal problems and athletic trainers are also encouraged to attend.

“Dr. Brown and HMI have assembled an impressive roster of authorities in the field of musculoskeletal health and sports medicine, and worked with local leaders in medicine to design a program respondent to the specific concerns of physicians in the region,” said Al Shunnar. “In addition to this program in September, plans are already underway to offer Practi-Med Dubai 2004 in December.”

Among the Harvard Medical School faculty who will join Brown in Dubai are Dr. William P. Docken, Dr. Mark J. Koris, and Dr. Tamara L. Martin, all of Brigham and Women’s Hospital, and Dr. Zacharia Isaac of Spaulding Rehabilitation Center. Faculty from Gulf Region academic medical centers will also be on hand to talk about local encounters with musculoskeletal health issues.

For more information about the program, please visit the website at http://www.practi-med.com. Those participating in the conference will be awarded a ‘Certificate of Attendance’ by Harvard Medical International.

Novartis CME program on cardiology is a success—second event planned

Fifty-six physicians gathered in Montreux, Switzerland in June for a continuing medical education (CME) program on advances in cardiology. Supported by Novartis Pharma Schweiz, a leading pharmaceutical and consumer health company, the two-day program assembled a distinguished faculty from Harvard Medical School, the University Hospital in Zurich, and Universitatsspital Bern to discuss lipid management, advances in treating hypertension, and the management of coronary artery disease and congestive heart failure. Now Dr. Gerald Smetana, a general internist and associate professor of medicine at Harvard Medical School and Beth Israel Deaconess Medical Center, is working again with Novartis and HMI to develop the program for the next event, set for November.

Dr. Gerald Smetana

“The June program was very successful, and we received great feedback from the physicians who attended,” said Smetana. “Many of the physicians noted that our program was more evidence-based than what they are accustomed to, and they appreciated the editorial independence of the lectures.”

Of the 40 participants surveyed following the event, 95 percent said they would eagerly participate in a follow-up course, and eighty percent noted that they established new contacts with fellow physicians during the program—an often unmentioned benefit of successful CME programs.

Smetana added that he was struck by the similarity of the health care challenges facing the Swiss and German physicians and his counterparts in the United States. “The makeup of their patient population and the diseases they are dealing with in primary care practice closely resemble the situation we see in the United States, particularly the increase of cardiovascular disease and its complications,” he said. “I was very impressed with the thoughtfulness of their questions and the rigor with which they approached the course. This was a sophisticated audience and we look forward to delivering more of these programs.”

The next program, which will be held in Lucerne November 19-20, is expected to draw about 80 cardiologists from Switzerland and Germany and will be presented in English, German, and French. Smetana said that this event will incorporate more breakout sessions that will provide the participants with more opportunities to interact with the faculty. Participants are encouraged to bring difficult cases to discuss in these smaller audience settings.

HMI and Novartis have applied for continuing medical education accreditation from the Swiss Society for General Practitioners, the Swiss Society for Internal Medicine, and the Swiss Society for Cardiology. Program participants will also receive a Harvard Medical International Certificate of Attendance. For more information or questions related to this program, please contact Peta Gillyatt at peta_gillyatt@hms.harvard.edu.

DHCC construction guided by novel review process

The creation of Dubai Healthcare City (DHCC) from 87 acres of bare land into 3.8 million square feet of integrated medical facilities accommodating some 30,000 employees presents an unprecedented challenge to health care facilities planners. A complex infrastructure must be constructed that is aligned with the clinical and research objectives of DHCC. For HMI, the project is an unusual opportunity to create—through the Center for Healthcare Planning and Quality (CPQ)—design standards that will support the medical services being offered at DHCC as well as the ongoing quality management efforts that are an underlying pillar of the whole complex.

“This project is amazing in terms of its scale,” said Judy Mitchell, AIA, HMI’s director of planning. “The review process we have developed promises to raise the level of facility design to support delivery of high quality clinical services. Investors, health care providers, and patients all stand to benefit.”

Because DHCC is being constructed in a free zone, without specific building regulations, the CPQ is tasked with establishing the standards for high-quality health care facilities at DHCC, and developing a process to ensure that those standards are met. “The standards and the review process must be very adaptable to different sets of needs,” said Mitchell. The entities seeking admission into DHCC include a broad range of providers ranging from large brand name institutions with sophisticated development teams to small private practitioners with strong track records in health care but limited building experience. Mitchell added, “The guidelines have been created not only to promote excellence, but to prevent any unnecessary barriers to qualified providers seeking entry into DHCC.”

Riaz Adamjee, acting director of planning for the CPQ, working with Marjan Faraidooni, licensing and quality coordinator for CPQ, has led the CPQ compliance review process from HMI’s Dubai offices. Adamjee stresses that “timely input is essential for the success of DHCC’s health care providers.” To meet this goal, the CPQ has structured a four-step feedback loop that tracks with a typical real estate development process. It begins with a review of an applicant’s credentials and an assessment of the proposed clinical program plan for appropriateness and “fit” within the larger mission of DHCC. The CPQ has contracted with the Dubai office of HOK, an international design firm with extensive experience in health care design, to provide technical input. Architectural and engineering reviews are conducted early so that input is proactive and troubleshooting occurs before detailed design begins. By the time a provider is ready to start construction, there should be no surprises.

To date, DHCC holds commitments for nearly all available land within the Dubai Healthcare City. Eighty percent of potential investors have entered into the initial phase of the review process, and of those some have advanced to detailed design. Construction is underway on 321,000 square feet of diagnostic clinics and medical office space, with occupancy expected as early as January 2005.

Popular BeST Resident program gets rave reviews from surgical residents

Surgical residents continue to make BeST Resident part of their preparation for the ABSITE examination, and residency directors across North America are paying attention. More than 30 academic medical centers in the United States alone have adopted the program. HMI and its partners are collaborating to make BeST Resident even better by enhancing the user experience and updating the content.

Basic electronic Surgical Training, or BeST Resident, was developed by HMI in partnership with the Royal College of Surgeons and Intumed, a leading e-learning company, to support the educational needs of surgery residents, medical students, and their mentors. The award-winning program was adapted for use in U.S.-based systems with the help of more than 100 surgical faculty members at Harvard Medical School. BeST Resident provides 180 hours of online interactive general surgical training for surgery residents and medical students, and accommodates residents’ and students’ lifestyles by allowing them to study anytime anywhere they have access to the Internet. Annually, medical experts review the material and make necessary updates to keep the content current.

One resident who has used BeST extensively reported that the program did more to prepare her for the ABSITE examination than didactic sessions or textbook review: “The information is current, and the pre- and post-exam question format really helped to solidify the information that was covered in the modules. The clinical scenarios are a great help to any practicing surgeon.”

Residents and surgical training programs can now purchase BeST licenses for a six-month duration. BeST is already offered for three-month, one-year, or three-year periods, and HMI still offers interested users a two-week free trial. BeST Resident can be purchased online at www.intumed.com.

HMI will be on hand at the annua Clinical Congress of the American College of Surgeons in New Orleans (October 10-14, 2004) to demonstrate BeST Resident and answer questions. For more information about BeST Resident, please contact Paulette Smiles, HMI program coordinator, at paulette_smiles@hms.harvard.edu.