As part of the global health hospital medicine fellowship, we are joining residents and fellows from Boston and Mexico for a week-long trip to Haiti, which serves as a “bootcamp” in global health delivery.

Last night, Paul Farmer joined our group to discuss the history and context of the work in Haiti.  He highlighted the immense progress of the global health field over the past 30 years.   Even as late as the 1990s and early 2000s, there was an ongoing debate in public health on whether to focus on prevention or treatment for HIV/AIDS in poor countries.  It was felt to be impractical and not “cost-effective” to treat HIV patients.  Instead, resources were to be directed towards prevention only.  Fortunately, advocacy and multiple new funding streams have helped to change this view, recognizing that the millions of people living with HIV/AIDS needed and deserved access to treatment.  It is only in the past few years that research has confirmed what many already knew; treatment is also a crucial tool for prevention, further emphasizing the false dichotomy of choosing one approach over the other.

Similarly, as Dr. Farmer pointed out last night, global health delivery requires investment across the spectrum of health care settings.  Health promotion in communities and building primary health care systems are essential components.  However, even in the best systems, people will get sick and will need hospital care.  We cannot hope to provide global health equity if we don’t also invest in this next level of care.  Zanmi Lasante has recently opened a state-of-the-art hospital in Mirebalais, Haiti with just that purpose.  As global health hospital medicine fellows, we will be working alongside our community partners this year in Haiti and Liberia with the hope of strengthening their hospital medicine systems.   Ideally, in the next 10 to 20 years, we will no longer have to debate whether to invest in community health versus primary care versus hospital care.  Instead, it will be recognized that these are all essential and interdependent pieces in delivering global health equity.

Robin Tittle, MD – UCSF Global Health – Hospital Medicine Fellow

The Global Health Fellows talking with Dr. Paul Farmer and Dr. Joia Mukherjee

Haiti