By: Bethsy Jacob, Pharm.D. Candidate c/o 2014
On November 16, 2011, Dr. Joia Mukherjee, Medical Director of Partners in Healthcare (PIH), presented for GlobeMed at Columbia University. Manzi Anatole, a hired nurse in Rwanda, accompanied Dr. Mukherjee. Along with a handful of her students, Dr. Joanne Carroll arranged a trip to the open event. The lecture highlighted key issues that affect healthcare in developing areas, particularly in Rwanda.
According to Dr. Mukherjee, the Universal Declaration of Human Rights is not as inclusive as it should be. This declaration embodies two covenants – the covenant of civil and political rights and the covenant of social and economic rights (such as the right to education and health). Too often in the United States, human rights are narrowed on political and civil rights – there is not enough focus on the other sets of rights, which are considered to be more like privileges. Yet, in third world countries, basic human needs are unmet. Therefore, their first concern is food for the family, followed by education and shelter. As important as it may be in the United States, voting (a political right) is not their primary need.
To provide these basic human needs, countries like Rwanda need sufficient money in their treasuries. These nations heavily rely on borrowing, which forces them to create a market-like economy and increase the private sector while minimizing the public sector. PIH works with these governments to support basic the ideology of healthcare as a human right (with the belief that the government is the only way that healthcare can be supported as a right). In the words of Dr. Mukherjee, “If it is a real right, then it is based on citizenship, not a charity.1” PIH also works side-by-side with the government to assist with public sector projects, such as the establishment of hospitals.
As with many third world countries, this problem is even more sophisticated in Rwanda because of the poor skill set of healthcare staff. Even with a supported government, the staff does not have the training necessary to treat patients. Most nurses in Rwanda have high school level education and play multiple roles (e.g. doctors and pharmacists). There are many non-governmental organizations (NGOs) that provide training to these nurses, but this has turned out to be counter-productive because training pulls large portions of the nurses from their clinical settings all at once, leaving few personnel to care for patients. Training via PowerPoint presentations is not efficient to the extent of helping these nurses on a clinical, practical level. There is no one to “catalyze” the training, and there is no follow-up or evaluate how well the nurses understand and practice the training they receive.
Manzi, Dr. Mukherjee’s colleague, realized the flaw within this system. According to Manzi, it is better to have poor quality of care than to pull the nurses from clinics that are already under-staffed. However, is there another option? Yes, it is to provide support and mentorship to these nurses on a local level. There is a program to train district nurses, who, in turn, mentor the local nurses within their healthcare clinics. These district nurses also help to apply the verbal training the local nurses receive. Through mentoring, the nurses can actualize what they learn.
Malaria, HIV, STIs, and opportunistic infections are significant causes of deaths in Rwanda, where the life expectancy is roughly 58 years. The situation requires an intervention to reduce morbidity and mortality. Mentorship is an effective, evidence-based intervention, but there are still many challenges ahead, with nurses leaving clinics to find other jobs, limited equipment despite proper training, and low levels of education. It is also difficult to expand the program to other districts in Rwanda. Reasonably, Manzi said, “Writing down on a piece of paper is different than actual practice. You can have a very good vision, but you need support. It is not enough to have a good vision.2” Even though we know what to do in Rwanda, there are too many challenges and too little support to fully promote and expand the intervention.
As pharmacy students, we train to cure, improve symptoms, and/or limit the progression of diseases and conditions. Many people do not have access to professionals with proper skill sets, technologies, vaccines, or medications. With our background, we should be aware of, and perhaps even support, causes that promote healthcare and social justice. As Dr. Paul Farmer says, “it is important to believe in human rights in spite of your own troubles.3” That goal is to change our world where no one starves, drinks impure water, or lives in fear of the powerful and violent. That world is a utopia and this world is a dystopia. Moving progressively away from this dystopia moves us progressively towards something better and more human.2
More information about Partners in Health is available at www.pih.org
- Mukherjee, Joia. “Partners in Health.” Lecture. Dr Joia Mukherjee and Manzi Anatole at GlobeMed Columbia University. Columbia University, New York City. 16 Nov. 2011.
- Anatole, Manzi. “Partners in Health.” Lecture. Dr Joia Mukherjee and Manzi Anatole at GlobeMed Columbia University. Columbia University, New York City. 16 Nov. 2011.
- Farmer, Paul. “Who We Are – Partners in Health.” Partners in Health. Web. 26 Dec. 2011. <http://www.pih.org/pages/who-we-are/>.