Human Resources for Health: Addressing Rwanda’s Shortage of Health Professionals

Sub-Saharan Africa bears 24% of the global burden of disease but is served by only 4% of the global health workforce. (WHO)

In four short weeks, I’ll be working as a Research Intern at the Rwanda Biomedical Center in Kigali; I have never been more excited to step out of my comfort zone than I am in this moment. The efforts taking place in Rwanda are a spectacular example of what it takes to rebuild a public health system. The 1994 genocide deteriorated Rwanda’s fragile economy and health infrastructure. As a result of the widespread violence, the nation experienced a significant loss of health care professionals and a steep increase in the prevalence of HIV/AIDS. (as of 2012, the estimated HIV prevalence is 2.9%). Concern over the Rwanda’s skyrocketing AIDS epidemic led the Government of Rwanda to collaborate with Partners in Health and the Clinton Health Access Initiative in 2005. This partnership has come a long way:

  • PIH supports the Government of Rwanda’s delivery of health care services to approx. 865,000 people through 3 hospitals and 40 health centers in Rwanda’s poorest regions. 
  • CHAI has worked in Rwanda since 2002 to scale up HIV/AIDS care and treatment, contribute to health infrastructure, and promote economic development.
  • In Aug 2013, CHAI and the Government of Rwanda announced a program that will combat malnutrition through collaboration with food producers, development of local food processing industries, and increased income for small holder farmers.

However, Rwanda still experiences a significant lack of human resources — physicians, nurses, midwives, management officials. The WHO recommends a minimum level of 2.3 health care providers per 1,000 population; Rwanda has a density of 0.84 providers per 1,000 population. In an effort to strengthen the nation’s health workforce, the Government of Rwanda and CHAI invited 25 American institutions (16 academic medical centers, six nursing schools, one public health school, and two dental schools) to form a 7-year partnership known as the Human Resources for Health program.

Through this initiative, health professionals from the United States- dentists, doctors, nurses, management officials, and midwives – will partner with Rwandan health professionals to exchange knowledge and skills that will promote the ability of the Rwandan health force to sustainably and comprehensively address their nation’s health needs. Each year, approximately 100 health workers from the United States will “twin” with colleagues in Rwanda.

Human Resources for Health was announced in 2012, and I am extremely excited to monitor and watch this initiative grow. Rwanda has shown immense dedication to eventually breaking free of dependence on foreign aid, and this is evident through efforts to improve and sustain health infrastructure, medical education, and proper health outcomes.

For more information on the Human Resources for Health program, visit:

The Official HRH website

NEJM article detailing the program


Bringing it Back to the (Global Health) Book Worm Days!

Let’s be truthful — I haven’t been reading leisurely over the past 3.5 years at NYU. I haven’t been reading much except NYT articles, truthfully. Now that I’ve graduated and I start the process of reassessing and re-inventing myself, my first step is to engage my mind and spirit with some moving, challenging works.

And so I present…. My (Global Health) reading list! I have many other texts outside the discipline that I’ve included, and that is because everything is interdisciplinary. History, economics, politics, health – they are all related.

I’m eager to blog more, and for now, enjoy!

Medicine and Culture
Will to Live
The Truth About Drug Companies
How Doctors Think
Partner to the Poor
When Doctors Don’t Listen
How to Repair the World
A Field Guide To Germs
The Origins of AIDS
The Self Regulation of Health and Illness Behavior
The Ghost Map
Six Months in Sudan
A Bed For the Night
Infections and Inequalities
Reimagining Global Health
Uncertain Suffering
Family Secrets
What to Eat
Pathologies of Power
Poor Economics
A Short History of Nearly Everything
 “War and Peace” by Leo Tolstoy
“The Rise of Theodore Roosevelt” by Edmund Morris
“The Life and Times of Lyndon B. Johnson” by Robert Caro
 “However Long the Night” by Aimee Molloy
 “The Heart and the Fist” by Eric Greitens
 “Why We Can’t Wait” and ” Where Do We Go from Here? Chaos or Community” by MLK
 “Born to Run” by Chris McDougall
Cutting for Stone by Abraham Verghese
How Wall Street Created a Nation: J.P. Morgan, Teddy Roosevelt, and the Panama Canal
The Prize: The Epic Quest for Oil, Money, and Power

Snapshot Sunday: Hungry Planet

Peter Menzel and Faith D’Aluisio traveled the world photographing everything that an average family consumes in a given week and noting the cost. Their results were exhibited in the Nobel Peace Center in an effort to raise awareness about “how environments and cultures influence the cost and calories of the world’s dinners.” (TIME Magazine)

Here are some of my favorites from the full slideshow:


India – 1,636.25 Indian Rupees or $39.27


Guatemala – 573 Quetzales or $75.70


Egypt – 387.85 Egyptian Pounds or $68.53


USA – $341.98


USA – $242.48


Mali – 17,670 Francs or $26.39






Great Britain – 155.54 British Pounds or $253.13

Think critically about these pictures… People of which countries, in general, are eating more balanced meals? How does culture influence food choice, especially in regard to developed vs. developing nation classifications?

To kick off the first week of October right, I’ll be focusing blog posts on nutrition. These pictures of meal comparisons around the world have always forced me to think critically about why Americans make the food choices we do and how we, as a nation, can focus more on taking up balanced eating.

Snapshot Sunday: Honor A Father’s Wish

On Friday, I wrote an article about the importance of empowering women to speak up against acts of sexual violence against themselves, or others. We have the power to change how society, especially Indian society, views rapists and those who have been raped.

Today’s return of Snapshot Sunday takes me back to the start: Honor Badri Singh Pandey’s wish. Jyoti Singh Pandey, his daughter, was gang-raped in December 2012. His wish – “We want the world to know her name. My daughter didn’t do anything wrong, she died while protecting herself.
I am proud of her. Revealing her name will give courage to other women who have survived these attacks. They will find strength from my daughter.”


Raise your voice, for yourself and those you care about. 

Links of interest that I highly recommend:

Sushmita Sen’s Speech at the Save & Empower the Girl Child Campaign Fashion Show

Sohaila Abdulali’s NYT piece “I Was Wounded; My Honor Wasn’t”


Snapshot Sunday: Inside the Mirebalais ER

I love alliteration, and I love Sundays. Here’s to the start of a new series – Snapshot Sunday.

mirebalais ER


The ER team was treating this patient’s complicated tibia/fibula fracture when this image was captured. As a huge supporter of PIH’s work across the globe and their model of accompaniment, I felt this was the best way to start the series. While I haven’t yet had the privilege to visit Mirebalais, I have toured the Butaro Hospital in Rwanda and I am proud to raise funds for PIH’s life saving work.

For some more info on PIH, check out the following:

“Mountains Beyond Mountains”, by Tracy Kidder


The Growing Movement: NCD screening and care in resource limited settings

I first learned about the growing necessity for NCD screening and care during my December 2011 trip to Rwanda with FACE AIDS and PIH.

At that point, the now-functioning Butaro Cancer Center of Excellence was a a work in progress. The Butaro Center, being rural East Africa’s first comprehensive cancer center, serves a symbol of what can be done with proper funding and will. Yet, this model and the growing recognition of NCDs as a major issue in resource limited areas, has brought one central question to the forefront of this movement: why isn’t chronic illness (such as cancer) screening integrated into primary care services in a more widespread, efficient manner?

While this question is one that I don’t have a solid answer for, I am using it as a framework for further research on this topic, and I invite you to do the same or take on some of the other recurring questions I’ve seen asked: What is the role of local educational institutions in creating cancer-care providers (such as oncologists, nurses, etc.) in order to allow long-term growth in cancer care infrastructure? Increasingly, how are non-profit organizations across the globe taking on provision of cancer-care and screening services, and what does the future of public sector-nonprofit sector partnerships in provision of these services look like?

For more in-depth, or area specific information on these topics, here are some potential links of interest:

HSPH Infographic: “Global Burden of Disease: Good News and Bad News”

the link between mental health and NCD care 

the adoption of an omnibus resolution on NCDS at the World Health Assembly in May 2013

One example from Uganda of how organizations are increasingly getting involved in cancer care 

The very complex topic of NCD screening and care provision, especially in resource limited settings, is one to watch.

Definitions of infertility + conception and why gender should be left out of them

As a preface, I have now learned that studying for the MCAT, surviving the responsibilities of the semester, and applying for various fellowships, leaves very little time to blog something constructive. But, I’m trying! This post was written as a reading response for my Medical Anthropology course at NYU for Part 3 of Margaret Lock and Vinh-Kim Nguyen’s “An Anthropology of Biomedicine”. For anyone looking to gain valuable insight into clinical and public health practices through the lens of anthropology, I recommend this text wholeheartedly. I actually recommend it to everyone… It’s lengthy but worth it. Alas, what follows is my response to Part 3 of this text. 

In Part 3 of Lock and Nguyen, the authors address how the creation and use of biological and technological entities made from living cell structures challenged traditional scientific and moral ideas around the body. Chapters 8-10 cover these themes by addressing the replacement of faulty/failing body parts and organs using new entities and how they promoted research using these technologies to enhance and replace many functions and parts of the human body. In Chapter 8, Lock and Nguyen present the commodification of eggs and sperm through case studies of cell lines and DNA data banking to address the question of ownership of the human body. In Chapter 9, the authors focus on organ and tissue transplantation as a specific type of bodily acquisition. The repercussions of organ sales and donations on kinship networks and national identity are explored, and transplants are considered through the lens of an intervention that maintains biological life in an otherwise non-alive body to allow the “living” to carry on. Lastly, in chapter 10, the authors focus on reproductive health by addressing the implementation and ramifications associated with reproductive health technologies and the intricacies of pushing fertility control on the political and socio-economic agenda, while research knowledge about infertility remains scarce, especially in low and middle income areas. In this reading response, I will be analyzing and asking questions about the idea of different definitions used across disciplines and cultures for a single condition.

I was very compelled by the differing definitions of infertility in relation to definitions presented by the WHO, presented by pg. 256. The initial WHO definition centered around a couple who hadn’t been able to conceive after a year of unprotected sex. Clinicians and epidemiologists altered this definition into terms that more suited their area of work and allowed them to maximize their findings. I want to reflect on this, because I’ve never thought about how individuals from various professional fields mold factual definitions of disease, illness, or differences into subjective definitions that focus heavily on particular aspects of the factual definition. In the case of epidemiologists and infertility, these individuals modified the definition to include “live births”, a phenomenon that could be much easily and more accurately monitored than conception. This example made me think of HIV/AIDS and the various definitions that HIV clinicians, researchers, social activists, and historians might use for the disease. An a current social activist and a future infectious disease physician (hopefully!), I currently define the illness as a communicable disease that deteriorates an individual’s immune system and leaves him or her susceptible to clinical, political, and socio-economic vulnerability and stigma. This definition takes into account who I am as a person: my social beliefs, my scientific knowledge, my perspective on what aspects of disease and illness are important. In a similar fashion, my definition of infertility is not gendered, unlike the majority of the definitions seen in Lock and Nguyen’s text. I define infertility as the inability of an individual to produce an offspring due to anatomical and physiological differences. There is no mention of gender, because, in my opinion, gender what you identify yourself as, not what your anatomy dictates. I believe that’s important, and at the risk of arguing with professionals from a wide array of fields, I think my definition works better than all gender-centric definitions.

As Chapter 10 makes clear, the role of the woman in contraception and birth is strictly defined in many regions of the world, including but not limited to examples from Egypt, Israel, and Sub-Saharan Africa. However, the social repercussions of allowing fertility to be viewed through the lens of gender are enormous. Women, as a population of individuals who are more likely to experience abuse and mistreatment, are the only one’s associated with these gendered definitions. Thus, we further add to traditional beliefs that the role of women in conception is of more significance, in both good and bad ways, than the role of the man. While this may lead to a sense of pride and identity of childbirth and conception as something inherently “womanly”, are we not also propagating the false ideas that woman are to be abandoned, to be blamed, to be ostracized for not being able to produce children? In some cases, the woman is fertile and capable of reproduction, but the man is not. The text illustrates Israel as an example of a nation that promotes reproduction, regardless of whether the childbearing woman is married or even going to raise the children herself. However, I worry that, overall, our definitions of diseases, illnesses, and differences can promote perceptions of social, cultural, political stigmatization and generalization, especially in regards to infertility and gender. I have to say, let’s leave gender out of infertility, and then create various definitions of the situation that emphasis the different aspects of life that are impacted by an individual and a couple’s (whether heterosexual or homosexual) to procreate.

Soda and global obesity

In my public health nutrition class, we’ve been talking a lot about the obesity epidemic in the United States. Without a doubt, children are heavier than they’ve been in the past, and diabetes is one of the top 10 leading causes of death in the US. Yet, I was shocked a few weeks ago when I learned that orange juice varieties commonly found in stores aren’t very different from sodas, and they contain absurd amounts of sugar making the “juices” unhealthy.

fun fact… did you know if you divide the grams of sugar per serving size listed on the label by 4, that value is the number of teaspoons of sugar per serving in the food/drink? 

Sugar-sweetened beverages, like juices and sodas, have definitely played a key role in the United States’ obesity epidemic. But how about around the world? I came across a study today that makes the following interesting points:

  • The rate of increase for soft drink sales is highest, outside of North America and Europe, in low and middle income countries.
  • Even a small increase in per capita soda consumption was associated with significant increases in weight, after controlling for other factors.
  • An increase in urbanization across the world is leading to more sedentary, stressful lifestyles which promote poor diet and less physical activity. As a result, we see lower health outcomes in low and middle countries, which are growing urban centers, as well.
  • Because soda consumption isn’t linked to economic development, people/nations still can experience economic growth without necessarily placing their populations at risk for obesity and related diseases.

Overall, I found that this analysis strengthens a lot of points that public health and nutrition professionals often point out. Sweetened beverages are definitely a key part of the global obesity epidemic, but they do not act alone. If we, as a society, are going to create and implement programs and policies that promote healthier lifestyles, we must study all the factors that lead to poor health outcomes and develop a holistic, well-rounded intervention.

Coming Soon! The Lancet Global Health

As a student, I have searched far and wide, throughout the masses of journals out there, for research within the discipline of global health. Finally, I am excited to share that the Lancet, the world’s oldest and one of the prominent medical journals, will be launching an online, open-access, reviewed journal titled The Lancet Global Health.

While the journal won’t be launching until June 2013, you can sign up for e-alerts and stay up to date with recent developments at this link. Also, they’re accepting paper submissions, so hey, try your luck 🙂